Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke.

Szlachetka, Weronika A.; Pana, Tiberiu A.; Tiamkao, Somsak; Clark, Allan B.; Kongbunkiat, Kannikar; Sawanyawisuth, Kittisak; Bettencourt-Silva, Joao H.; Kasemap, Narongrit; Mamas, Mamas A.; Myint, Phyo K.

Abstract

Background: Patients with diabetes mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited. Objectives: We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients. Methods: We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type. Results: Mean age (SD) was 64.3 (13.7) years, 44.9% were female with 61% IS, 28% HS and 11% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p < 0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HRmax (99% CI) at t = 4108 days: 1.54 (1.27, 1.86) and HR (99% CI) = 1.27(1.23,1.32), respectively. In HS, HRmax (t = 4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HRmax (t = 455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge. Conclusions: Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and stroke recurrence.

Citation

Szlachetka, W. A., Pana, T. A., Tiamkao, S., Clark, A. B., Kongbunkiat, K., Sawanyawisuth, K., Bettencourt-Silva, J. H., Kasemap, N., Mamas, M. A., & Myint, P. K. (2020). Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke. Global Heart, 15(1), 1-12. https://doi.org/10.5334/gh.364

• Journal Article Type: Article
• Acceptance Date: Nov 23, 2019
• Online Publication Date: Feb 6, 2020
• Publication Date: Feb 6, 2020
• Journal: Global Heart
• Print ISSN: 2211-8160
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 1
• Article Number: 2
• Pages: 1-12
• DOI: https://doi.org/10.5334/gh.364
• Keywords: diabetes mellitus, stroke, mortality, recurrence, complications, Thailand
• Public URL: https://keele-repository.worktribe.com/output/417450
• Publisher URL: https://globalheartjournal.com/article/10.5334/gh.364/