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Predictors of long-term survival after stroke in Taiwan
Der-Sheng Han1, Shin-Liang Pan, Ssu-Yuan Chen
1Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan, ROC.
Objective:
To determine the risk factors of long-term survival after stroke.
Design:
A prospective, hospital-based cohort study.
Subjects:
A total of 449 consecutive patients after acute stroke from 2 medical centres, within a 1-year period, were included.
Methods:
Dysphagia was confirmed with the water-swallow test within the first week after stroke. Data on co-morbidities and clinical risk factors were collected through chart review. Survival curves and independent risk factors were evaluated with Kaplan-Meier analysis and multivariate Cox proportion hazards analysis, respectively.
Results:
A total of 424 patients were followed for 10 years, and the survival was 54.2%. In univariate analysis, history of diabetes mellitus and recurrent stroke, dysphagia, urinary incontinence, cognitive impairment, tube feeding, dysarthria, and drooling were associated with higher mortality. In multivariate analysis, old age, history of recurrent stroke, and diabetes mellitus were independent predictors of long-term survival. The leading causes of death were cerebro-vascular diseases and malignancy during the 10-year post-stroke period.
Conclusion:
Dysphagia was not an independent determinant of post-stroke survival. History of recurrent stroke and diabetes mellitus were independent predictors of long-term survival. These results suggest that differential treatment strategies should be used in the different stages of stroke.