Factors That Increase Death Risk in Young Stroke Patients Identified

Heavy drinking, 45-49 years of age, type 1 diabetes mellitus, or having a preceding infection are associated with more than twice the risk of death in stroke patients 15 to 49 years old, according to a new study.

Researchers at Helsinki University Central Hospital (HUCH, Finland) analyzed five-year mortality data of all consecutive patients aged 15 to 49 with first-ever ischemic stroke treated at HUCH from January 1994 to September 2003. The researchers followed the patients using data from the Finnish mortality registry of statistics, and used life-table analyses for calculating mortality risks. Kaplan-Meier method allowed comparisons of survival between clinical subgroups, and the Cox proportional hazard model was used for identifying predictors of mortality. Stroke severity was measured using the U.S. National Institutes of Health Stroke Scale and the Glasgow Coma Scale.

The researchers found that among the 731 patients followed, 78 died. Cumulative mortality risks were 2.7% at one month, 4.7% at one year, and 10.7% at five years, with no gender difference. Those over 45 years of age had lower probabilities of survival. Among the 30-day survivors, stroke caused 21% of the subsequent deaths, cardioaortic and other vascular problems caused 36%, malignancies cause 12%, and infections a further 9% of the deaths. Malignancy, heart failure, heavy drinking, preceding infection, type 1 diabetes, increasing age, and large artery atherosclerosis independently predicted five-year mortality adjusted for age, gender, relevant risk factors, stroke severity, and etiologic subtype. In all, the researchers found that heart failure was associated with 7 times the risk of death, and active cancer malignancy with 16 times the risk of death in stroke patients. The study was published in the July 9, 2009, issue of Stroke.

"Despite the overall low mortality after an ischemic stroke in young adults, several recognizable subgroups had substantially increased risk of death in the long term,” concluded lead author Jukka Putaala, M.D., and colleagues of the department of neurology. "Detecting these factors associated with higher risk of death is important because they can be modified by lifestyle changes, strictly controlled medication or medical procedures in most patients,”

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