Risk Factors for Stroke in Patients With Sepsis and Bloodstream Infections

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, Ninth Revision 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 1 year. Associations between risk factors, also defined by International Classification of Diseases, Ninth Revision 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% (odds ratio, 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. Conclusions- 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.

Keywords: epidemiology; heart failure; pulmonary circulation; risk factors sepsis.

Figure 1.

Receiver Operating Characteristics (ROC) Curve Analysis for Composite Risk Score Predicting Stroke after Sepsis or Bloodstream Infection