Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

Weronika A. Szlachetka; Tiberiu Pana; Somsak  Tiamkao; Allan B. Clark; Kannikar Kongbunkiat; Joao H. Bettencourt-Silva; Kittisak  Sawanyawisuth; Narongrit Kasemap; Mamas A. Mamas; Phyo K. Myint

doi:10.5334/gh.364

Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

Weronika A. Szlachetka
, Tiberiu Pana
, Somsak Tiamkao
, Allan B. Clark
, Kannikar Kongbunkiat
, Joao H. Bettencourt-Silva
, Kittisak Sawanyawisuth
, Narongrit Kasemap
, Mamas A. Mamas
, Phyo K. Myint^*

^*Corresponding author for this work

Khon Kaen University
University of East Anglia
University of Aberdeen
University of Cambridge
Keele University

Research output: Contribution to journal › Article › peer-review

36 Citations (Scopus)

15 Downloads (Pure)

Abstract

Background: Patients with Diabetes Mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited. Objectives: We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients. Methods: We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type. Results: Mean age (SD) was 64.3 (13.7) years, 44.9% were female with 61% IS, 28% HS and 11% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p<0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HRmax (99%CI) at t=4108 days: 1.54 (1.27, 1.86) and HR(99%CI) = 1.27(1.23,1.32), respectively. In HS, HRmax (t=4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HRmax (t=455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge. Conclusions: Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and recurrence.

Original language	English
Article number	2
Number of pages	12
Journal	Global Heart
Volume	15
Issue number	1
Early online date	6 Feb 2020
DOIs	https://doi.org/10.5334/gh.364
Publication status	Published - 2020

Bibliographical note

ACKNOWLEDGEMENTS

WAS received the Institute of Applied Health Sciences Aberdeen Summer Research Scholarship (ASRS) to carry out the research. The authors would like to thank Mr Jesus A Perdomo-Lampignano BSc for his assistance with graphics post-processing. We gratefully acknowledge the National Health Security Office (NHSO) of Thailand for providing the data.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

diabetes mellitus
stroke
mortality
recurrence
complications
Thailand

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Cite this

@article{1e0020695fcb4d11a8a5d73adb3cc3f7,

title = "Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke",

abstract = "Background: Patients with Diabetes Mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited. Objectives: We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients. Methods: We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type. Results: Mean age (SD) was 64.3 (13.7) years, 44.9\% were female with 61\% IS, 28\% HS and 11\% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p<0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HRmax (99\%CI) at t=4108 days: 1.54 (1.27, 1.86) and HR(99\%CI) = 1.27(1.23,1.32), respectively. In HS, HRmax (t=4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HRmax (t=455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge. Conclusions: Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and recurrence.",

keywords = "diabetes mellitus, stroke, mortality, recurrence, complications, Thailand",

author = "Szlachetka, \{Weronika A.\} and Tiberiu Pana and Somsak Tiamkao and Clark, \{Allan B.\} and Kannikar Kongbunkiat and Bettencourt-Silva, \{Joao H.\} and Kittisak Sawanyawisuth and Narongrit Kasemap and Mamas, \{Mamas A.\} and Myint, \{Phyo K.\}",

note = "ACKNOWLEDGEMENTS WAS received the Institute of Applied Health Sciences Aberdeen Summer Research Scholarship (ASRS) to carry out the research. The authors would like to thank Mr Jesus A Perdomo-Lampignano BSc for his assistance with graphics post-processing. We gratefully acknowledge the National Health Security Office (NHSO) of Thailand for providing the data.",

year = "2020",

doi = "10.5334/gh.364",

language = "English",

volume = "15",

journal = "Global Heart",

issn = "2211-8160",

publisher = "Ubiquity Press",

number = "1",

}

TY - JOUR

T1 - Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

AU - Szlachetka, Weronika A.

AU - Pana, Tiberiu

AU - Tiamkao, Somsak

AU - Clark, Allan B.

AU - Kongbunkiat, Kannikar

AU - Bettencourt-Silva, Joao H.

AU - Sawanyawisuth, Kittisak

AU - Kasemap, Narongrit

AU - Mamas, Mamas A.

AU - Myint, Phyo K.

N1 - ACKNOWLEDGEMENTS WAS received the Institute of Applied Health Sciences Aberdeen Summer Research Scholarship (ASRS) to carry out the research. The authors would like to thank Mr Jesus A Perdomo-Lampignano BSc for his assistance with graphics post-processing. We gratefully acknowledge the National Health Security Office (NHSO) of Thailand for providing the data.

PY - 2020

Y1 - 2020

N2 - Background: Patients with Diabetes Mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited. Objectives: We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients. Methods: We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type. Results: Mean age (SD) was 64.3 (13.7) years, 44.9% were female with 61% IS, 28% HS and 11% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p<0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HRmax (99%CI) at t=4108 days: 1.54 (1.27, 1.86) and HR(99%CI) = 1.27(1.23,1.32), respectively. In HS, HRmax (t=4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HRmax (t=455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge. Conclusions: Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and recurrence.

AB - Background: Patients with Diabetes Mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited. Objectives: We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients. Methods: We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type. Results: Mean age (SD) was 64.3 (13.7) years, 44.9% were female with 61% IS, 28% HS and 11% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p<0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HRmax (99%CI) at t=4108 days: 1.54 (1.27, 1.86) and HR(99%CI) = 1.27(1.23,1.32), respectively. In HS, HRmax (t=4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HRmax (t=455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge. Conclusions: Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and recurrence.

KW - diabetes mellitus

KW - stroke

KW - mortality

KW - recurrence

KW - complications

KW - Thailand

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U2 - 10.5334/gh.364

DO - 10.5334/gh.364

M3 - Article

C2 - 32489775

SN - 2211-8160

VL - 15

JO - Global Heart

JF - Global Heart

IS - 1

M1 - 2

ER -

Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

Abstract

Bibliographical note

UN SDGs

Keywords

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