Epidemiologic features and risk factors of sepsis in ischemic stroke patients admitted to intensive care: A prospective cohort study

Background/objective: Stroke is the second leading cause of death globally that predisposed to sepsis. Therefore, this study was aimed to assess the risk factors and epidemiologic features of sepsis in ischemic stroke patients admitted to ICUs. Methods: Throughout this prospective study, we investigated all severe ischemic stroke patients admitted to ICUs of Namazi and Ali-Ashghar Hospitals in Shiraz. After ICU admission and diagnosing stroke by a neurologist according to NIHSS (National Institute of Health Stroke Scale) criteria, sepsis work-up was performed in all patients suspected to have sepsis. Then the incidence of sepsis and its risk factors in ICU admitted stroke patients were determined. Results: A total of 149 patients were screened in this study. The mean age of the participants was 65.37 +/- 15.40 years old and 57.4% of them were male. Hypertension was the most common coexistent disease (74.6%) in stroke patients. Seventy-six patients (62.3%) were diagnosed with sepsis and pneumonia was the most common infection leading to sepsis in stroke patients. Our data showed significant differences between two groups in terms of APACHE-IV score (P < 0.001), NIHSS and APS (P < 0.001) before ICU admission (P < 0.001) and NIHSS at admission (P < 0.001); however, age (P = 0.07) and sex (P = 0.17) were not significantly different between the groups. Logistic regression analysis displayed that severe stroke (NIHSS = 21-42, OR = 49.09) and severe loss of consciousness (GCS < 8, OR = 27.95) at admission were the most essential predictive factors for sepsis after ischemic stroke. Conclusions: This study showed that ICU patients with severe ischemic stroke were more susceptible to sepsis during the hospital course. (C) 2019 Published by Elsevier Ltd.