Factors affecting the occurrence of gastrointestinal bleeding in acute ischemic stroke patients

Gastrointestinal bleeding (GIB) is a common complication that occurs after stroke, and GIB may negatively affect patient prognosis. In this study, we aimed to examine: (1) the risk factors of GIB in acute cerebral infarction patients; (2) association between GIB and 1-year mortality in patients with acute cerebral infarction. Patients with acute cerebral infarction were divided into 2 groups based on the occurrence of GIB during acute stroke stage. Patient characteristics, clinical presentation, stroke risk factors, comorbidities, laboratory data, medication, and outcomes were investigated to analyze the associations between the variables and the probability of having GIB. In addition, patients in the study were matched individually by age, gender. A 1:1 matched case-control method and conditional logistic regression models for single and multiple factors were used to assess the risk factors of GIB in acute cerebral infarction patients. Clinical data of patients with acute cerebral infarction were reviewed and analyzed during the years 2015 and 2016. Finally, 1662 patients with acute cerebral infarction were included in this study, of whom 139 (8.5%) patients had GIB at admission. Multivariate logistic regression analysis revealed that the independent risk factors for GIB in patients with acute cerebral infarction were advanced age (OR=1.030, P=.009), low Glasgow Coma Scale (GSC) score (OR=0.850, P=.014), infection (OR=4.693, P<.001), high NIHSS score (OR=1.114, P=.001), and posterior circulation infarction (OR=4.981, P=.010). The case-control study ultimately included 136 case-control pairs. Stepwise conditional regression analyses revealed that the independent risk factors for GIB in patients with acute cerebral infarction were low Glasgow Coma Scale (GSC) score (RR=0.645, P=.011), infection (RR=15.326, P=.001), and posterior circulation infarction (RR=6.129, P=.045). The group with GIB had a higher rate of mortality and disability level (mRS grade >= 4) than the group without GIB (P<.001) within 1 year after stroke. In addition, independent risk factors of death within 1 year after stroke in patients were GIB (OR=6.096, P<.001), infection (OR=4.493, P<.001), mRS grade >= 4 (OR=4.129, P<.001), and coronary heart disease (OR=3.718, P=.001). GIB is a common complication after ischemic stroke. These identified factors may help clinicians identify risks of GIB before it develops. GIB is associated with increased risk of 1-year mortality and poor functional outcome in acute cerebral infarction patients.