What influences outcome of stroke--pyrexia or dysphagia?

To investigate the significance of pyrexia and dysphagia as risk factors for mortality at 90 days in patients admitted with an acute stroke when controlled with other confounding factors, 202 stroke patients admitted to acute medical wards were prospectively studied for demographic and neurological details, stroke syndromes and pathology. A number of other factors were recorded within three days of admission, including pyrexia and dysphagia. Cox's proportional hazards model was used to identify the effect of 10 factors on mortality at 90 days; 59 (29%) patients had died by 90 days. Univariate analysis revealed pyrexia and dysphagia to be independently and significantly associated with indices of stroke severity and 90 day mortality (p < 0.001 for both). Cox's proportional hazards model, however, revealed that stroke mortality was associated with dysphagia (relative risk 2.6, 95% CI 1.2-5.4; p = 0.009), pre-existing diabetes mellitus (2.4, CI 1.2-4.5; p = 0.006), higher age > 75 years (1.8, CI 1.0-3.1), ischaemic heart disease (2.1, CI 1.1-4.2, p = 0.025), total anterior circulation syndromes (2.8, CI 1.5-5.2) and previous stroke (1.8, CI 1.0-3.2, p = 0.028). Pyrexia was not a significant factor (p = 0.50). Although both pyrexia and dysphagia are associated with higher mortality in acute stroke patients, dysphagia was a significant variable predicting death at 90 days when controlled for other factors known to influence stroke mortality. Pyrexia is not significant when other variables are considered.