Previous infection and stroke: a prospective study

Abstract

Background: Previous studies have demonstrated that infections might precipitate ischemic strokes (IS). We sought to describe, in a large prospective series, the frequency of previous infection (PI) in IS and intracerebral hemorrhage (ICH), and to assess whether any relationship with stroke subtype or outcome could be identified.

Methods: Between January 2005 and December 2010, we studied 1,981 patients with acute stroke. The presence of PI within the month before the stroke was prospectively assessed. PI was correlated with demographic data, vascular risk factors, stroke subtype, and 3-month outcome.

Results: A total of 193 (9.7%) patients had suffered a PI, the most common being respiratory tract infections (36.8%), flu or flu-like illness (30.1%), and gastrointestinal infections (12.4%). PI was more frequent in IS cases (10.2%) than in ICH (6.8%) (p = 0.081). Among IS cases, no differences were seen between PI and TOAST subtypes (p = 0.644). For IS, patients with PI were older (p = 0.025), had worse previous functional status (p = 0.002), suffered a more severe stroke (p = 0.002), achieved poor outcome (p = 0.001), and had higher 3-month mortality (p = 0.019). Multivariate analysis showed that IS patients with PI had previous poor functional status (OR = 1.58; p = 0.026) and suffered more severe strokes (OR = 1.02, p = 0.048). After adjustment for confounders, PI has no independent influence on 3-month outcome (OR = 1.15; p = 0.564).

Conclusions: PI are observed in 9.7% of stroke cases without differences according to the TOAST subtype. PI are associated with previous poor functional status and with stroke severity, but have no independent influence on the 3-month outcome.