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Predictors of In-Hospital Mortality in Patients With Acute Ischemic Stroke Treated With Thrombolytic Therapy
Peter U. Heuschmann, MD, MPH;
Peter L. Kolominsky-Rabas, MD;
Joachim Roether, MD;
Bjoern Misselwitz, MPH;
Klaus Lowitzsch, MD;
Jan Heidrich, MD;
Peter Hermanek, MD;
Carsten Leffmann, MD;
Matthias Sitzer, MD;
Marcel Biegler, MD;
Hans-Joachim Buecker-Nott, MD;
Klaus Berger, MD, MPH; for the German Stroke Registers Study Group
JAMA. 2004;292:1831-1838.
Context Data are limited regarding the risks and benefits of thrombolytic therapy for acute ischemic stroke outside of clinical trials.
Objective To investigate predictors of in-hospital mortality in patients with ischemic stroke treated with intravenous tissue plasminogen activator (tPA) within a pooled analysis of large German stroke registers.
Design and Setting Prospective, observational cohort study conducted at 225 community and academic hospitals throughout Germany cooperating within the German Stroke Registers Study Group.
Patients A total of 1658 patients with acute ischemic stroke who were admitted to study hospitals between 2000 and 2002 and were treated with tPA.
Main Outcome Measure In-hospital mortality.
Results One hundred sixty-six patients (10%) who received tPA died during hospitalization, with 67.5% of these deaths occurring within 7 days. Factors predicting in-hospital death after tPA use were older age (for each 10-year increment in age, adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.9) and altered level of consciousness (adjusted OR, 3.4; 95% CI, 2.4-4.7). The overall rate of symptomatic intracranial hemorrhage was 7.1% and increased with age. One or more serious complications was observed in 27.2% of all patients and in 83.9% of patients who died after tPA treatment. An inverse relation between the number of patients treated with tPA in the respective hospital and the risk of in-hospital death was observed (adjusted OR, 0.97; 95% CI, 0.96-0.99 for each additional patient treated with tPA per year).
Conclusion In patients with ischemic stroke who are treated with tPA, disturbances of consciousness and increasing age are associated with increased in-hospital mortality.
Author Affiliations: Institute of Epidemiology and Social Medicine, University of Muenster (Drs Heuschmann, Heidrich, and Berger), and Department of Quality Assurance, Westphalian Board of Physicians (Dr Buecker-Nott), Muenster, Germany; Unit for Stroke Research and Public Health Medicine, Department of Neurology, University of Erlangen, Erlangen, Germany (Dr Kolominsky-Rabas); Department of Neurology, University of Hamburg Eppendorf (Dr Roether), and Coordination Centre for Quality-Management Projects at the Hamburg Hospital Federation (Dr Leffmann), Hamburg, Germany; Institute of Quality Assurance Hesse, Eschborn, Germany (Mr Misselwitz);Stroke Register Rhineland-Palatine/SQMed (Dr Lowitzsch) and Institute of Quality Assurance Rhineland-Palatine/SQMed (Dr Biegler), Mainz, Germany; Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (Dr Hermanek); and Department of Neurology, University of Frankfurt, Frankfurt, Germany (Dr Sitzer).
Corresponding Author: Peter U. Heuschmann, MD, MPH, Institute of Epidemiology and Social Medicine, University of Muenster, Domagkstrasse 3, 48149 Muenster, Germany (heuschma{at}uni-muenster.de).
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