Increased risk of stroke after septicaemia: a population-based longitudinal study in Taiwan

PLoS One. 2014 Feb 21;9(2):e89386. doi: 10.1371/journal.pone.0089386. eCollection 2014.

Abstract

Inflammation and infection have been noted to increase stroke risk. However, the association between septicaemia and increased risk of stroke remains unclear. This population-based cohort study, using a National Health Insurance database, aimed to investigate whether patients with septicaemia are predisposed to increased stroke risk. The study included all patients hospitalised for septicaemia for the first time between 2000 and 2003 without prior stroke. Patients were followed until the end of 2010 to evaluate incidence of stroke. An age-, gender- and co-morbidities-matched cohort without prior stroke served as the control. Cox's proportional hazards regressions were used to assess differences in stroke risk between groups. Based on hazard ratios (HRs), patients with septicaemia had greater stroke risk, especially in the younger age groups (age <45: HR = 4.16, 95% CI: 2.39-7.24, p<0.001; age 45-64: HR = 1.76, 95% CI: 1.41-2.19, p<0.001; age ≥ 65: HR = 1.05, 95% CI: 0.91-1.22, p>0.05). Haemorrhagic stroke was the dominant type (ischaemic stroke: HR = 1.20, 95% CI: 1.06-1.37, p<0.01; haemorrhagic stroke: HR = 1.82, 95% CI: 1.35-2.46, p<0.001) and patients without co-morbidities were at slightly higher risk (without co-morbidities: HR = 1.49, 95% CI: 1.02-2.17, p<0.05; with co-morbidities: HR = 1.24, 95% CI: 1.10-1.41, p<0.001). The impact of septicaemia on stroke risk was highest within 6 months of the event and gradually declined over time. Our results suggest that septicaemia is associated with an increase in stroke risk, which is greatest in haemorrhagic stroke. Closer attention to patients with history of septicaemia may be warranted for stroke preventive measures, especially for younger patients without co-morbidities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / epidemiology
  • Comorbidity
  • Databases, Factual
  • Diabetes Mellitus / epidemiology
  • Female
  • Humans
  • Hypertension / epidemiology
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Myocardial Ischemia / epidemiology
  • Risk
  • Sepsis / complications*
  • Stroke / epidemiology*
  • Stroke / etiology
  • Taiwan

Grant support

This study was supported in part by the Tri-Service General Hospital grants (TSGH-C98-11-S02; TSGH-C99-010-11-S02; TSGH-C100-006-010-11-S02), Ministry of Health and Welfare grant (DOH101-TD-B-111-004), Academia Sinica Taiwan Biobank - Stroke Biosignature Project (BM102021169), Tseng-Lien Lin Foundation, Taiwan Brain Disease Foundation and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.