Risk Factors for Stroke in Patients with Sepsis and Bloodstream Infections

• Authors: Iris Yuefan Shao, Emory University; Mitchell SV Elkind, Columbia University; Amelia K Boehme, Columbia University
• Journal Title: STROKE
• Volume: Volume 50, Number 5
• Publisher: American Heart Association | 2019-05-01, Pages 1046-1051
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/STROKEAHA.118.023443
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Stroke; Sepsis; Population at Risk; Epidemiology

Abstract

Background and Purpose: Sepsis has been identified as a trigger for stroke, but the underlying mechanisms and risk factors that predispose patients with sepsis to increased stroke risk remain unclear. We sought to identify predictors of stroke after sepsis and bloodstream infections. Methods: The 2007 – 2009 California State Inpatient Database from the Health Care Utilization Project was used to identify patients over the age of 18 years and hospitalized with sepsis or bloodstream infection defined by International Classification of Diseases (ICD-9) codes. Patients who died during their sepsis hospitalization were excluded. The primary outcome was a primary diagnosis of ischemic or hemorrhagic stroke on a subsequent hospitalization within one year. Associations between risk factors, also defined by ICD-9 codes, and stroke were analyzed using multivariable logistic regression. A composite risk score was generated to predict stroke risk. Results: Of 121,947 patients with sepsis, 0.5% (n=613) had a primary diagnosis of stroke within a year of their sepsis hospitalization. Significant predictors for stroke were identified. A score was generated from these risk factors with points assigned based on regression coefficients: valvular heart diseases (1 point), congestive heart failure (1), renal failure (1), lymphoma (2), peripheral vascular diseases (2), pulmonary circulation disorders (2), and coagulopathy (3). The C-statistic for the receiver operating characteristic curve for the score was 0.68. The risk of stroke increased 43% (OR = 1.43, 95% CI: 1.37, 1.48) per point increase in the score. The effect of increase in score was greater among younger patients. Conclusion: Risk factors and a composite risk score for stroke may help identify a subpopulation of sepsis patients that could be targeted to reduce the short-term risk of stroke after serious infections.