Jens Sundbøll1, Erzsébet Horváth-Puhó2, Morten Schmidt2, Olaf M Dekkers2, Christian F Christiansen2, Lars Pedersen2, Hans Erik Bøtker2, Henrik T Sørensen2. 1. From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (J.S., E.H.-P., M.S., C.F.C., L.P., H.T.S.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark (H.E.B.); Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands (O.M.D.); and Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands (O.M.D.). jens.sundboll@clin.au.dk. 2. From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (J.S., E.H.-P., M.S., C.F.C., L.P., H.T.S.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark (H.E.B.); Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands (O.M.D.); and Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands (O.M.D.).
Abstract
BACKGROUND AND PURPOSE: The prognostic impact of glucocorticoids on stroke mortality remains uncertain. We, therefore, examined whether preadmission use of glucocorticoids is associated with short-term mortality after ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). METHODS: We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all patients with a first-time inpatient diagnosis of stroke between 2004 and 2012. We categorized glucocorticoid use as current use (last prescription redemption ≤90 days before admission), former use, and nonuse. Current use was further classified as new or long-term use. We used Cox regression to compute 30-day mortality rate ratios with 95% confidence intervals (CIs), controlling for confounders. RESULTS: We identified 100 042 patients with a first-time stroke. Of these, 83 735 patients had ischemic stroke, 11 779 had ICH, and 4528 had SAH. Absolute mortality risk was higher for current users compared with nonusers for ischemic stroke (19.5% versus 10.2%), ICH (46.5% versus 34.4%), and SAH (35.0% versus 23.2%). For ischemic stroke, the adjusted 30-day mortality rate ratio was increased among current users compared with nonusers (1.58, 95% CI: 1.46-1.71), driven by the effect of glucocorticoids among new users (1.80, 95% CI: 1.62-1.99). Current users had a more modest increase in the adjusted 30-day mortality rate ratio for hemorrhagic stroke (1.26, 95% CI: 1.09-1.45 for ICH and 1.40, 95% CI: 1.01-1.93 for SAH) compared with nonusers. Former use was not substantially associated with mortality. CONCLUSIONS: Preadmission use of glucocorticoids was associated with increased 30-day mortality among patients with ischemic stroke, ICH, and SAH.
BACKGROUND AND PURPOSE: The prognostic impact of glucocorticoids on stroke mortality remains uncertain. We, therefore, examined whether preadmission use of glucocorticoids is associated with short-term mortality after ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). METHODS: We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all patients with a first-time inpatient diagnosis of stroke between 2004 and 2012. We categorized glucocorticoid use as current use (last prescription redemption ≤90 days before admission), former use, and nonuse. Current use was further classified as new or long-term use. We used Cox regression to compute 30-day mortality rate ratios with 95% confidence intervals (CIs), controlling for confounders. RESULTS: We identified 100 042 patients with a first-time stroke. Of these, 83 735 patients had ischemic stroke, 11 779 had ICH, and 4528 had SAH. Absolute mortality risk was higher for current users compared with nonusers for ischemic stroke (19.5% versus 10.2%), ICH (46.5% versus 34.4%), and SAH (35.0% versus 23.2%). For ischemic stroke, the adjusted 30-day mortality rate ratio was increased among current users compared with nonusers (1.58, 95% CI: 1.46-1.71), driven by the effect of glucocorticoids among new users (1.80, 95% CI: 1.62-1.99). Current users had a more modest increase in the adjusted 30-day mortality rate ratio for hemorrhagic stroke (1.26, 95% CI: 1.09-1.45 for ICH and 1.40, 95% CI: 1.01-1.93 for SAH) compared with nonusers. Former use was not substantially associated with mortality. CONCLUSIONS: Preadmission use of glucocorticoids was associated with increased 30-day mortality among patients with ischemic stroke, ICH, and SAH.
Authors: Nicholas J Parkinson; Harold C McKenzie; Michelle H Barton; Jennifer L Davis; Bettina Dunkel; Amy L Johnson; Elizabeth S MacDonald Journal: J Vet Intern Med Date: 2018-02-20 Impact factor: 3.333