BACKGROUND AND PURPOSE: Little is known about the acute precipitants of ischemic stroke, although evidence suggests infections contribute to risk. We hypothesized that acute hospitalization for infection is associated with the short-term risk of stroke. METHODS: The case-crossover design was used to compare hospitalization for infection during case periods (90, 30, or 14 days before an incident ischemic stroke) and control periods (equivalent time periods exactly 1 or 2 years before stroke) in the Cardiovascular Health Study, a population-based cohort of 5888 elderly participants from 4 US sites. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by conditional logistic regression. Confirmatory analyses assessed hazard ratios of stroke from Cox regression models, with hospitalization for infection as a time-varying exposure. RESULTS: During a median follow-up of 12.2 years, 669 incident ischemic strokes were observed in participants without a baseline history of stroke. Hospitalization for infection was more likely during case than control time periods; for 90 days before stroke, OR=3.4 (95% CI, 1.8 to 6.5). The point estimates of risks were higher when we examined shorter intervals: for 30 days, OR=7.3 (95% CI, 1.9 to 40.9), and for 14 days, OR=8.0 (95% CI, 1.7 to 77.3). In survival analyses, risk of stroke was associated with hospitalization for infection in the preceding 90 days, adjusted hazard ratio=2.4 (95% CI, 1.6 to 3.4). CONCLUSIONS: Hospitalization for infection is associated with a short-term increased risk of stroke, with higher risks observed for shorter intervals preceding stroke.
BACKGROUND AND PURPOSE: Little is known about the acute precipitants of ischemic stroke, although evidence suggests infections contribute to risk. We hypothesized that acute hospitalization for infection is associated with the short-term risk of stroke. METHODS: The case-crossover design was used to compare hospitalization for infection during case periods (90, 30, or 14 days before an incident ischemic stroke) and control periods (equivalent time periods exactly 1 or 2 years before stroke) in the Cardiovascular Health Study, a population-based cohort of 5888 elderly participants from 4 US sites. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by conditional logistic regression. Confirmatory analyses assessed hazard ratios of stroke from Cox regression models, with hospitalization for infection as a time-varying exposure. RESULTS: During a median follow-up of 12.2 years, 669 incident ischemic strokes were observed in participants without a baseline history of stroke. Hospitalization for infection was more likely during case than control time periods; for 90 days before stroke, OR=3.4 (95% CI, 1.8 to 6.5). The point estimates of risks were higher when we examined shorter intervals: for 30 days, OR=7.3 (95% CI, 1.9 to 40.9), and for 14 days, OR=8.0 (95% CI, 1.7 to 77.3). In survival analyses, risk of stroke was associated with hospitalization for infection in the preceding 90 days, adjusted hazard ratio=2.4 (95% CI, 1.6 to 3.4). CONCLUSIONS: Hospitalization for infection is associated with a short-term increased risk of stroke, with higher risks observed for shorter intervals preceding stroke.
Authors: J David Curb; Robert D Abbott; Beatriz L Rodriguez; Pamela Sakkinen; Jordan S Popper; Katsuhiko Yano; Russell P Tracy Journal: Circulation Date: 2003-04-07 Impact factor: 29.690
Authors: R F Macko; S F Ameriso; A Gruber; J H Griffin; J A Fernandez; R Barndt; F P Quismorio; J M Weiner; M Fisher Journal: Stroke Date: 1996-11 Impact factor: 7.914
Authors: Armin J Grau; Alexander W Boddy; Deborah A Dukovic; Florian Buggle; Christoph Lichy; Tobias Brandt; Werner Hacke Journal: Stroke Date: 2004-03-11 Impact factor: 7.914
Authors: Michael F Byrne; Steven W Kerrigan; Paul A Corcoran; John C Atherton; Frank E Murray; Desmond J Fitzgerald; Dermot M Cox Journal: Gastroenterology Date: 2003-06 Impact factor: 22.682
Authors: Logan T Cowan; Alvaro Alonso; James S Pankow; Aaron R Folsom; Wayne D Rosamond; Rebecca F Gottesman; Kamakshi Lakshminarayan Journal: Stroke Date: 2016-05-10 Impact factor: 7.914
Authors: S Reza Jafarzadeh; Benjamin S Thomas; David K Warren; Jeff Gill; Victoria J Fraser Journal: Clin Infect Dis Date: 2016-05-18 Impact factor: 9.079