Non-neurological complications of acute stroke: frequency and influence on clinical outcome

Understanding the nature and clinical relevance of non-neurological complications is crucial to provide an appropriate management to patients with acute stroke. The aims of this study in patients with acute stroke were to assess the in-hospital frequency of non-neurological complications and the correlation between these complications and adverse outcome (death or disability) at 3 months. Patients with acute ischemic or hemorrhagic stroke admitted to the Stroke Unit of the University of Perugia were included in a prospective cohort study. Pre-defined non-neurological complications were considered for study purposes. Study outcomes were 3-month death and composite of death and disability. Stroke was defined as not disabling (mRS 0–2) or disabling (mRS 3–5) or leading to death (mRS 6). Multiple logistic regression analysis was used to identify predictors for study outcomes. 1,101 consecutive patients (mean age 72.2 ± 13.1 years; 57.1% males; 926 ischemic and 175 hemorrhagic) were included in the study; 338 patients (30.7%) experienced at least one non-neurological complication. 269 patients (24.4%) had fever, 210 patients (19.1%) infection in one or more sites, 86 patients (7.8%) venous thromboembolism (VTE) and 34 patients (3.0%) myocardial infarction. At 3 months, 511 patients (46.4%) were disabled and 123 had died (11.2%). Regression logistic analysis found that: (1) age (OR 1.06 for 1 added year; 95% CI 1.03–1.08), NIHSS score on admission (OR 1.31 for 1 added point; 95% CI 1.25–1.38), current smoking (OR 1.92; 95% CI 1.08–3.39), infection in any site (OR 4.13; 95% CI 1.51–11.28) and VTE (OR 6.03; 95% CI 1.44–25.11) were associated with death and/or disability (mRS ≥ 3) and that (2) age (OR 1.06 for 1 added year; 95% CI 1.02–1.09), high NIHSS score on admission (OR 1.21 for 1 added point; 95% CI 1.15–1.27), male gender (OR 1.93; 95% CI 1.04–3.62), fever (OR 2.29; 95% CI 1.08–4.86) and myocardial infarction (OR 6.57; 95% CI 2.30–18.74) were associated with increased mortality. In conclusions, patients with acute stroke are at high risk of non-neurological complications, such as fever with or without infections, venous thromboembolism and myocardial infarction. Non-neurological complications are associated with increased long-term disability and death.