Henrikas Kazlauskas, Rima Radžiuvienė, Vinsas Janušonis
The purpose of the study was to identify relationships between clinical characteristics, time and costs of the treatment in patients with post-stroke pneumonia and uro-infection. The retrospective analysis included 256 patients with acute stroke, who were treated in the stroke unit of Klaipėda university hospital in 2010. Medical records of patients with stroke (form 003/a) were used as a data source. Brain computer tomography was applied to all patients included in the study. Pneumonia and urinary tract infection diagnosis (ICD-10, codes J18 and N39.0, respectively) was established based on the clinical, laboratory and radiological analysis and the appropriate specialist’s consultation. The statistical analysis was performed using SPSS 15. The chi-square (χ2) test and Spearman correlation coefficient (r) were used to determine the relationship between characteristics. The linkage of complications to the type of stroke, gender, age and duration of treatment was established by applying logistic regression. The data difference was statistically significant at p <0.05.
The mean age of patients included in the study was 71.3 ± 11.9 years. It was found in the course of the study that 32 patients (12.5 percent) were diagnosed with post-stroke pneumonia and 6 patients (3.2 percent) with urinary tract infection, accordingly. Older age appeared to be linked to the development of after stroke pneumonia OR = 1.08 (1.04 to 1.14), p <0.001. Urinary tract infection, regardless of gender and age, was associated with hemorrhagic stroke (OR = 9.6, p = 0.027). A median of 9 bed days was observed, range 1 to 22 days. Pneumonia and urinary tract infection increased the length of inpatient treatment (median 13 days, range 7 to 22 days). The treatment duration of patients with pneumonia and urinary tract infection exceeded one and a half times that of patients without complications [OR = 1.52 (1.29 to 1.78) and 1.51 (1.17 to 1.94), respectively]. Significantly higher treatment costs per patient were observed in patients with pneumonia (43 percent above the average costs for the treatment of patients without complications, p <0.001) and urinary tract infection (51 percent above the treatment of patients without complications) (p=0,002) compared with treatment costs of patients who had no complications.
Conclusions: Post-stroke pneumonia and urinary tract infection (12.5 and 3.2 percent, respectively) are common complications of acute stroke, the frequency of which depends on the stroke severity.
The treatment duration of patients who had been diagnosed with pneumonia and urinary tract infection exceeded one and a half times that of patients without complications. Treatment costs for patients with post-stroke pneumonia and uro-infection are significantly higher compared to patients for whom these complications were not diagnosed. Effective prevention and management of early complications after acute stroke is needed.
Keyword(s): acute stroke, post-stroke pneumonia, uro-infection, cost
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