Abstract WMP15: Temporal Trends In Medical Complications After Acute Ischemic Strokes In The United States From 2006-2017

To evaluate age and sex-specific trends in prevalence of infectious and non-infectious complications (comps) following acute ischemic stroke (AIS) admissions in the United States (US) from 2006 to 2017. We identified all admissions with a primary AIS diagnosis (weighted n= 5,190,311) in the 2006-2017 National Inpatient Sample. We quantified the prevalence of infectious [pneumonia, sepsis, and urinary tract infection (UTI)] and non-infectious [acute kidney injury (AKI), acute myocardial infarction (AMI), deep venous thrombosis (DVT), pulmonary embolism (PE), gastrointestinal bleeding (GIB) hemorrhage and acute myocardial infarction (AMI)] comps in subgroups categorized by age and sex. Logistic regression models were used to evaluate trends in prevalence over time. Across the study period, 24.3% of all AIS admissions had at least one comp but prevalence increased with age. UTI (12.2%) was the most common comp, but this was driven mainly by its high prevalence in older females (f) 60-79 y (16.0%) and F >=80 y (22.9%). AKI was the second most common comp (8.9%) in all patients, followed by pneumonia (3.3%) and AMI (2.7%). GIB (1.1%), DVT (0.9%), and PE (0.5%) were the least common. Any comp risk increased from 20.8% in 2006 to 25.9% in 2017. Risk of UTI and pneumonia declined over time (p <0.001) but this was more than counterbalanced by increased risk of noninfectious comps such as AKI, AMI, DVT, and PE (figure 1). This was most prominent for AKI where there was a >3-fold increase in risk across the study period (figure 1). After multivariable adjustment, AKI, AMI, PE, pneumonia, sepsis, and GIB were associated with increased odds of in-hospital death while UTI and DVT were inversely associated with mortality (all p-values < 0.01). Infectious comps declined, while noninfectious comps, particularly AKI, increased following AIS admissions from 2006 to 2017. Additional efforts are needed to minimize comp risk following AIS.

Duke Scholars

Author Carl Mhina