Risk factors for in-hospital mortality among acute ischemic stroke patients in China: a nationwide prospective study

ABSTRACT

Objective: We aimed to investigate factors related to in-hospital mortality (IHM) in acute ischemic stroke (AIS) patients.

Methods: We prospectively investigated 827,314 patients who were admitted within 7 days of AIS between August 2015 and July 2019. Demographic characteristics, risk factors, and clinical and laboratory characteristics of patients were assessed. Univariate and multivariate logistic regression analyses were performed to identify predictors associated with IHM.

Results: The IHM rate in this study was 0.5% in women and 0.3% in men. Factors associated with IHM in AIS included diabetes (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.03–1.43), female (OR 0.84, 95%CI 0.74–0.96), hypertension (OR 1.16, 95%CI 1.01–1.34), atrial fib/flutter (OR 1.51, 95%CI 1.29–1.77), other heart disease (OR1.43, 95%CI 1.23–1.67), prior myocardial infarction (OR 2.00, 95%CI 1.54–2.60), antiplatelet therapies (OR 0.71, 95%CI 0.60–0.84), gastrointestinal bleeding (OR 3.54, 95%CI 2.83–4.44), pulmonary embolism (OR 2.53, 95%CI1.41–4.53), dysphagia(OR7.32, 95%CI6.23–8.61), glycosylated hemoglobin (OR1.05, 95%CI 1.02–1.09), serum creatinine (OR 1.001, 95%CI 1.001–1.002), urea nitrogen (OR 1.10, 95%CI 1.08–1.12), National Institutes of Health Stroke Scale (NIHSS) score (4–5 vs. 0–4: OR 3.58; ≥15 vs. 0–4: OR 8.78), stroke rehabilitation (OR 0.27, 95%CI 0.23–0.30), age (third IQR vs. first IQR: OR 1.57; fourth IQR vs. first IQR: OR 2.23), and in-hospital stroke/TIArecurrence (OR 2.38, 95%CI 2.03–2.78).

Conclusions: The findings from this study may help clinicians control the risk of IHM better for patients with AIS.

KEYWORDS:

• Ischemic stroke
• in-hospital mortality
• risk factor
• prognosis

Acknowledgments

We thank the CSCA collaborating centers, members, and volunteers for their hard work and efforts. We thank every participant who has contributed important and invaluable data to CSCA.

Author contributions

Study concept and design: all authors. Data collection: all authors. Data analysis: HQG. Manuscript drafting: all authors. Study supervision: YJW and ZXL. All authors critically reviewed the manuscript and agreed on this final version to be submitted to the journal.

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

This work was supported by the Ministry of Science and Technology of the People’s Republic of China [National Key R&D Programme of China, 2017YFC1310901, 2016YFC0901002, 2017YFC1307905, 2015BAI12B00], National Natural Science Foundation of China [No. 81801152], Beijing Talents Project [2018A13, 2018000021223ZK03], Youth Programme [QML20180501], CAMS Innovation Fund for Medical Sciences (2019-I2M-5-029), Beijing Municipal Committee of Science and Technology (Z201100005620010), Beijing Natural Science Foundation (Z200016).

Notes on contributors

Zhi-Xin Huang

Zhi-Xin Huang, MD., Ph.D., Associate Professor of Neurology, Supervisor of postgraduates of Southern Medical University, Nanhua University and Guangdong University of Technology. Good at Cerebral Vascular Intervention. Mainly engaged in the related research of endothelial progenitor cells, arteriosclerosis, ischemic stroke and cerebrovascular intervention.

Hong-Qiu Gu

Hong-Qiu Gu, MD., Ph.D., Dr. Gu primarily interested in health care quality assessment and improvement in cerebrovascular disease; statistical design, statistical analysis, predictive model, and machine learning with their applications in cardiology and neurology. In addition to his research interests, he has broad experiences in literate programming, data visualization, and reproducible research.

Xin Yang

Xin Yang, MD., Ph.D., Dr. Yang primarily interested in health care quality assessment and improvement in cerebrovascular disease; clinical research design. In addition to her research interests, she has broad clinical experiences on neurological diseases.

Chun-Juan Wang

Chun-JuanWang, MD., Ph.D., Professor of Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.

Yong‐Jun Wang

Yong-jun Wang, MD., Executive Vice President, Beijing Tiantan Hospital, Capital Medical University; Director of Neurology Department, Beijing Tiantan Hospital; Vice President of China National Clinical Research Center for Neurological Diseases; Director, Beijing Acute Stroke Emergency Care Center; Director, China Stroke Training Center; Advisor of PhD and MD, Capital Medical University; Executive Vice Chair, Chinese Stroke Association; President of Neurology Branch, Chinese Medical Association.

Zi‐Xiao Li

Zixiao Li, MD., Ph.D., Associate Professor of Neurology. Director of Center for Healthcare Quality and Research, China National Clinical Research Center for Neurological Diseases, Office Director of National Center for Healthcare Quality Management in Neurological Diseases, and Vice Director of Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University. His research focuses on stroke care delivery quality assessment, implementation, and improvement in China. He assisted to establish a nationwide network for stroke care quality including 2494 secondary and tertiary hospitals in China and develop a web-based patient management tool to collect the stroke care delivery data from this nationwide network.  He also developed a multifaceted quality improvement intervention for stroke care, designed and conducted a cluster randomized clinical trial to identify that this multifaceted quality improvement intervention can improve hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke and decrease 1-year new vascular events. This finding was published in JAMA in 2018 (doi:10.1001/jama.2018.8802).