An Analysis of Long-Term Ischemic Stroke Risk in Survivors of Septicemia

Chun An Cheng, Chun Gu Cheng, Jiuun Tay Lee, Hung Che Lin, Cheng Chung Cheng, Hung Wen Chiu

Research output: Contribution to journalArticle

Abstract

Introduction: Sepsis increases the long-term incidence of ischemic stroke (IS). The chances for long-term IS in patients who are discharged after sepsis are unclear. Our aim was to demonstrate long-term risk chance. s of IS after septicemia discharge. We used a nomogram to identify those septicemia survivors with the higher risk of developing IS. Methods: Inpatient data were used from the Taiwan Longitudinal Health Insurance Database, from 2001 to 2003. The event was IS rehospitalization after discharge of septicemia. We used multivariate Cox proportional regression of the risk factors for IS in septicemia survivors to create a nomogram. Results: There were 642 IS incidents in this study. The risk factors for IS in survivors of septicemia were advanced age (hazard ratio [HR] 1.035 [95% confidence interval (CI) 1.029-1.042]), new-onset atrial fibrillation (HR 1.875 [95% CI 1.327-2.651]), hypertension (HR 2.042 [95% CI 1.687-2.471]), diabetes mellitus (HR 1.735 [95% CI 1.469-2.05]), coronary artery disease (HR 1.661 [95% CI 1.408-1.96]), chronic kidney disease (HR 1.264 [95% CI 1.071-1.49]), chronic obstructive pulmonary disease (HR 1.201 [95% CI 1.016-1.421]), and local hospital admission (HR 1.414 [95% CI 1.155-1.731]). The model showed good calibration and discrimination, with a bootstrap-corrected concordance index of .785. Conclusion: With this prognostic nomogram, we found age with the strongest factor for IS. There was increased IS incidence with more comorbid conditions in advance-aged septicemia survivors. Physicians must identify high IS-risk patients and control risk factors to prevent adverse events in the clinical setting.

Original languageEnglish
JournalJournal of Stroke and Cerebrovascular Diseases
DOIs
Publication statusAccepted/In press - 2017

Fingerprint

Survivors
Sepsis
Stroke
Confidence Intervals
Nomograms
Incidence
Health Insurance
Taiwan
Chronic Renal Insufficiency
Atrial Fibrillation
Chronic Obstructive Pulmonary Disease
Calibration
Inpatients
Coronary Artery Disease
Diabetes Mellitus
Databases
Hypertension
Physicians

Keywords

  • Ischemic stroke
  • Nomogram
  • Risk
  • Septicemia

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

An Analysis of Long-Term Ischemic Stroke Risk in Survivors of Septicemia. / Cheng, Chun An; Cheng, Chun Gu; Lee, Jiuun Tay; Lin, Hung Che; Cheng, Cheng Chung; Chiu, Hung Wen.

In: Journal of Stroke and Cerebrovascular Diseases, 2017.

Research output: Contribution to journalArticle

Cheng, Chun An ; Cheng, Chun Gu ; Lee, Jiuun Tay ; Lin, Hung Che ; Cheng, Cheng Chung ; Chiu, Hung Wen. / An Analysis of Long-Term Ischemic Stroke Risk in Survivors of Septicemia. In: Journal of Stroke and Cerebrovascular Diseases. 2017.
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abstract = "Introduction: Sepsis increases the long-term incidence of ischemic stroke (IS). The chances for long-term IS in patients who are discharged after sepsis are unclear. Our aim was to demonstrate long-term risk chance. s of IS after septicemia discharge. We used a nomogram to identify those septicemia survivors with the higher risk of developing IS. Methods: Inpatient data were used from the Taiwan Longitudinal Health Insurance Database, from 2001 to 2003. The event was IS rehospitalization after discharge of septicemia. We used multivariate Cox proportional regression of the risk factors for IS in septicemia survivors to create a nomogram. Results: There were 642 IS incidents in this study. The risk factors for IS in survivors of septicemia were advanced age (hazard ratio [HR] 1.035 [95{\%} confidence interval (CI) 1.029-1.042]), new-onset atrial fibrillation (HR 1.875 [95{\%} CI 1.327-2.651]), hypertension (HR 2.042 [95{\%} CI 1.687-2.471]), diabetes mellitus (HR 1.735 [95{\%} CI 1.469-2.05]), coronary artery disease (HR 1.661 [95{\%} CI 1.408-1.96]), chronic kidney disease (HR 1.264 [95{\%} CI 1.071-1.49]), chronic obstructive pulmonary disease (HR 1.201 [95{\%} CI 1.016-1.421]), and local hospital admission (HR 1.414 [95{\%} CI 1.155-1.731]). The model showed good calibration and discrimination, with a bootstrap-corrected concordance index of .785. Conclusion: With this prognostic nomogram, we found age with the strongest factor for IS. There was increased IS incidence with more comorbid conditions in advance-aged septicemia survivors. Physicians must identify high IS-risk patients and control risk factors to prevent adverse events in the clinical setting.",
keywords = "Ischemic stroke, Nomogram, Risk, Septicemia",
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T1 - An Analysis of Long-Term Ischemic Stroke Risk in Survivors of Septicemia

AU - Cheng, Chun An

AU - Cheng, Chun Gu

AU - Lee, Jiuun Tay

AU - Lin, Hung Che

AU - Cheng, Cheng Chung

AU - Chiu, Hung Wen

PY - 2017

Y1 - 2017

N2 - Introduction: Sepsis increases the long-term incidence of ischemic stroke (IS). The chances for long-term IS in patients who are discharged after sepsis are unclear. Our aim was to demonstrate long-term risk chance. s of IS after septicemia discharge. We used a nomogram to identify those septicemia survivors with the higher risk of developing IS. Methods: Inpatient data were used from the Taiwan Longitudinal Health Insurance Database, from 2001 to 2003. The event was IS rehospitalization after discharge of septicemia. We used multivariate Cox proportional regression of the risk factors for IS in septicemia survivors to create a nomogram. Results: There were 642 IS incidents in this study. The risk factors for IS in survivors of septicemia were advanced age (hazard ratio [HR] 1.035 [95% confidence interval (CI) 1.029-1.042]), new-onset atrial fibrillation (HR 1.875 [95% CI 1.327-2.651]), hypertension (HR 2.042 [95% CI 1.687-2.471]), diabetes mellitus (HR 1.735 [95% CI 1.469-2.05]), coronary artery disease (HR 1.661 [95% CI 1.408-1.96]), chronic kidney disease (HR 1.264 [95% CI 1.071-1.49]), chronic obstructive pulmonary disease (HR 1.201 [95% CI 1.016-1.421]), and local hospital admission (HR 1.414 [95% CI 1.155-1.731]). The model showed good calibration and discrimination, with a bootstrap-corrected concordance index of .785. Conclusion: With this prognostic nomogram, we found age with the strongest factor for IS. There was increased IS incidence with more comorbid conditions in advance-aged septicemia survivors. Physicians must identify high IS-risk patients and control risk factors to prevent adverse events in the clinical setting.

AB - Introduction: Sepsis increases the long-term incidence of ischemic stroke (IS). The chances for long-term IS in patients who are discharged after sepsis are unclear. Our aim was to demonstrate long-term risk chance. s of IS after septicemia discharge. We used a nomogram to identify those septicemia survivors with the higher risk of developing IS. Methods: Inpatient data were used from the Taiwan Longitudinal Health Insurance Database, from 2001 to 2003. The event was IS rehospitalization after discharge of septicemia. We used multivariate Cox proportional regression of the risk factors for IS in septicemia survivors to create a nomogram. Results: There were 642 IS incidents in this study. The risk factors for IS in survivors of septicemia were advanced age (hazard ratio [HR] 1.035 [95% confidence interval (CI) 1.029-1.042]), new-onset atrial fibrillation (HR 1.875 [95% CI 1.327-2.651]), hypertension (HR 2.042 [95% CI 1.687-2.471]), diabetes mellitus (HR 1.735 [95% CI 1.469-2.05]), coronary artery disease (HR 1.661 [95% CI 1.408-1.96]), chronic kidney disease (HR 1.264 [95% CI 1.071-1.49]), chronic obstructive pulmonary disease (HR 1.201 [95% CI 1.016-1.421]), and local hospital admission (HR 1.414 [95% CI 1.155-1.731]). The model showed good calibration and discrimination, with a bootstrap-corrected concordance index of .785. Conclusion: With this prognostic nomogram, we found age with the strongest factor for IS. There was increased IS incidence with more comorbid conditions in advance-aged septicemia survivors. Physicians must identify high IS-risk patients and control risk factors to prevent adverse events in the clinical setting.

KW - Ischemic stroke

KW - Nomogram

KW - Risk

KW - Septicemia

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