Hospitalization for Infection and Risk of Acute Ischemic Stroke The Cardiovascular Health Study

• Published in: Stroke (1970) 2011-07, Vol.42 (7), p.1851-1856
• Main Authors: ELKIND, Mitchell S. V, CARTY, Cara L, O'MEARA, Ellen S, LUMLEY, Thomas, LEFKOWITZ, David, KRONMAL, Richard A, LONGSTRETH, W. T
• Format: Article
• Language: English
• Subjects: Bacterial Infections - complications; Bacterial Infections - diagnosis; Biological and medical sciences; Brain Ischemia - complications; Brain Ischemia - diagnosis; Cardiology - methods; Cohort Studies; Cross-Over Studies; Female; Follow-Up Studies; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hospitalization; Humans; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Odds Ratio; Proportional Hazards Models; Regression Analysis; Risk; Stroke - complications; Stroke - diagnosis; Time Factors; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.110.608588

Little is known about the acute precipitants of ischemic stroke, although evidence suggests infections contribute to risk. We hypothesized that acute hospitalization for infection is associated with the short-term risk of stroke. The case-crossover design was used to compare hospitalization for infection during case periods (90, 30, or 14 days before an incident ischemic stroke) and control periods (equivalent time periods exactly 1 or 2 years before stroke) in the Cardiovascular Health Study, a population-based cohort of 5888 elderly participants from 4 US sites. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by conditional logistic regression. Confirmatory analyses assessed hazard ratios of stroke from Cox regression models, with hospitalization for infection as a time-varying exposure. During a median follow-up of 12.2 years, 669 incident ischemic strokes were observed in participants without a baseline history of stroke. Hospitalization for infection was more likely during case than control time periods; for 90 days before stroke, OR=3.4 (95% CI, 1.8 to 6.5). The point estimates of risks were higher when we examined shorter intervals: for 30 days, OR=7.3 (95% CI, 1.9 to 40.9), and for 14 days, OR=8.0 (95% CI, 1.7 to 77.3). In survival analyses, risk of stroke was associated with hospitalization for infection in the preceding 90 days, adjusted hazard ratio=2.4 (95% CI, 1.6 to 3.4). Hospitalization for infection is associated with a short-term increased risk of stroke, with higher risks observed for shorter intervals preceding stroke.