Predicting 3-month mortality among patients hospitalized for first-ever acute ischemic stroke

Background: The clinical course of patients with acute ischemic stroke tends to be unstable. Understanding the factors contributing to the progression of stroke is important for the appropriate management of patients. This study investigated the factors related to 3-month mortality at admission in patients with first-ever acute ischemic stroke. Methods: Patients with first-ever acute ischemic stroke consecutively admitted to a medical center in Taiwan within 48 hours after stroke onset were prospectively followed-up for 3 months. All deaths during this 3-month post-stroke period were analyzed. We evaluated only those characteristics that could be assessed at admission. Multivariate logistic regression analysis was used to identify the main predictors of 3-month stroke-related mortality. Results: In the 360 enrolled patients, the inhospital mortality rate was 7.8% (28 deaths), and the 3-month mortality rate was 9.7% (35 deaths). Twenty-seven deaths (77%) were stroke-related. Risk factors for mortality at 3 months included sex (odds ratio [OR], 3.18; 95% confidence interval Cl], 1.08-9.41; p = 0.036), National Institutes of Health Stroke Scale (NIHSS) at admission (per unit increase: OR, 1.17; 95% Cl, 1.12-1.22; p < 0.001), history of cardiac disease (OR, 2.73; 95% Cl, 1.04-7.16; p = 0.042), and posterior circulation stroke (OR, 5.25; 95% Cl, 1.92-14.36; p = 0.001). Conclusion: This study of hospital-based data on patients with first-ever acute ischemic stroke in Taiwan found that initial NIHSS, posterior circulation stroke and history of cardiac disease were risk factors for 3-month mortality. [J Formos Med Assoc 2006;105(4):310-317].