Decompressive hemicraniectomy: predictors of functional outcome in patients with ischemic stroke

OBJECT Patients presenting with large-territory ischemic strokes may develop intractable cerebral edema that puts them at risk of death unless intervention is performed. The purpose of this study was to identify predictors of outcome for decompressive hemicraniectomy (DH) in ischemic stroke. METHODS The authors conducted a retrospective electronic medical record review of 1624 patients from 2006 to 2014. Subjects were screened for DH secondary to ischemic stroke involving the middle cerebral artery, internal carotid artery, or both. Ninety-five individuals were identified. Univariate and multivariate analyses were performed for an array of clinical variables in relationship to functional outcome according to the modified Rankin Scale (mRS). Clinical outcome was assessed at 90 days and at the latest follow-up (mean duration 16.5 months). RESULTS The mean mRS score at 90 days and at the latest follow-up post-DH was 4. Good functional outcome was observed in 40% of patients at 90 days and in 48% of patient at the latest follow-up. The mortality rate at 90 days was 18% and at the last follow-up 20%. Univariate analysis identified a greater likelihood of poor functional outcome (mRS scores of 4–6) in patients with a history of stroke (OR 6.54 [95% CI1.39–30.66]; p = 0.017), peak midline shift (MLS) > 10 mm (OR 3.35 [95% CI 1.33–8.47]; p = 0.011), or a history of myocardial infarction (OR 8.95 [95% CI1.10–72.76]; p = 0.04). Multivariate analysis demonstrated elevated odds of poor functional outcome associated with a history of stroke (OR 9.14 [95% CI 1.78–47.05]; p = 0.008), MLS > 10 mm (OR 5.15 [95% CI 1.58–16.79; p = 0.007), a history of diabetes (OR 5.63 [95% CI 1.52–20.88]; p = 0.01), delayed time from onset of stroke to DH (OR 1.32 [95% CI 1.02–1.72]; p = 0.037), and evidence of pupillary dilation prior to DH (OR 4.19 [95% CI 1.06–16.51]; p = 0.04). Patients with infarction involving the dominant hemisphere had higher odds of unfavorable functional outcome at 90 days (OR 4.73 [95% CI 1.36–16.44]; p = 0.014), but at the latest follow-up, cerebral dominance was not significantly related to outcome (OR 1.63 [95% CI 0.61–4.34]; p = 0.328). CONCLUSIONS History of stroke, diabetes, myocardial infarction, peak MLS > 10 mm, increasing duration from onset of stroke to DH, and presence of pupillary dilation prior to intervention are associated with a worse functional outcome.

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Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.0514 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Fauchier ◽

A Bisson ◽

A Bodin ◽

J Herbert ◽

T Genet ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Risk Of Death ◽

Increased Risk ◽

History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

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Serum omentin-1 is a novel biomarker for predicting the functional outcome of acute ischemic stroke patients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0282 ◽

2018 ◽

Vol 56 (2) ◽

pp. 350-355 ◽

Cited By ~ 9

Author(s):

Tian Xu ◽

Peng Zuo ◽

Yuqin Wang ◽

Zhiwei Gao ◽

Kaifu Ke

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Logistic Model ◽

Critical Role ◽

Stroke Onset ◽

Stroke Patients ◽

Multivariable Logistic Regression Model ◽

Poor Functional Outcome

Abstract Background: Recent studies have suggested that omentin-1 plays a critical role in the development of cardiovascular disease. However, reported findings are inconsistent, and no study has evaluated the association between omentin-1 levels and a poor functional outcome after ischemic stroke onset. Methods: A total of 266 acute ischemic stroke patients were included in this study. All patients were prospectively followed up for 3 months after acute ischemic stroke onset and a poor functional outcome was defined as a major disability or death occurring during the follow-up period. A multivariable logistic model was used to evaluate the association between serum omentin-1 levels and the functional outcome of ischemic stroke patients at 3 months. Results: Ischemic stroke patients with poor functional outcome had significantly lower levels of serum omentin-1 than patients without poor functional outcome at the 3-month follow-up (50.2 [40.2–59.8] vs. 58.3 [44.9–69.6] ng/mL, p<0.01). Subjects in the highest tertile of serum omentin-1 levels had a 0.38-fold risk of having poor functional outcome, compared with those in the lowest tertile (p<0.05). A negative association between omentin-1 levels and poor functional outcome was found (p for trend=0.02). The net reclassification index was significantly improved in predicting poor functional outcome when omentin-1 data was added to the multivariable logistic regression model. Conclusions: Higher omentin-1 levels at baseline were negatively associated with poor functional outcome among ischemic stroke patients. Omentin-1 may represent a biomarker for predicting poor functional outcome of acute ischemic stroke patients.

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Abstract T P118: Left Ventricle Ejection Fraction as Prognostic Factor of Functional Outcome in Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.tp118 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Fernando Gongora-Rivera ◽

Walter Muruet ◽

Jackeline Lara-Campos ◽

Héctor J Villarreal-Montemayor ◽

Héctor J Villarreal-Velázquez ◽

...

Keyword(s):

Ischemic Stroke ◽

Prognostic Factor ◽

Left Ventricle ◽

Ejection Fraction ◽

Functional Outcome ◽

Multivariate Logistic Regression Analysis ◽

Left Ventricle Ejection Fraction ◽

Poor Functional Outcome ◽

Good Functional Outcome

Background: Ischemic stroke is a leading cause of functional disability worldwide. Few studies have evaluated the relationship between Left Ventricle Ejection Fraction (LVEF) and the functional outcome after ischemic Stroke, however it has been shown that there is an important correlation between LVEF and Cerebral Blood Flow (CBF). The effects of LVEF on CBF may have critical implications on the post-ischemic brain. Objective: To determine if LVEF can be used as a prognostic factor in ischemic stroke Methods: We carried out a prospective, analytic, cohort study. We included stroke patients from our Neurovascular Resgistry (iReNe). We only included patients with complete information and that agreed to participate in the study. LVEF was measured during patients’ in-hospital stay. Clinical Follow up was done at 3 and 12 months using the modified Rankin Scale (mRs). Results: We included 129 patients with follow up at 3 months, from these, 69.5% of them had follow up at 12 months. Our study population was composed of 65.9% males, the mean age was 62.88 ± 13.18, 60.5% had hypertension, 49.6% diabetes mellitus, 27.9% dyslipidemia. Stroke subtypes according to TOAST were 38% atherothrombotic, 27.1% small vessel disease, 21.7% Cardioembolic and 13.2% were undetermined. The proportion of patients that died was 9.3%. We found that patients with good functional outcome (mRs 0-3) at 3 months had a mean LVEF of 57.22 vs an mean LVEF of 53.13 for the patients in the poor functional outcome group (mRs 4-6), p=0.020; Patients with good functional outcome (mRs 0-3) at 12 months had a mean LVEF of 57.38 vs 49.29 for patients with poor functional outcome (mRs 4-6), p=0.029. After performing a multivariate logistic regression analysis adjusted for sex, age and admission NIHSS, we found that LVEF maintained statistical significance. Conclusions: We found that a reduce LVEF is a factor of long term poor functional outcome in patients with ischemic stroke. Our results suggest that even relatively small reductions in LVEF may have a detrimental effect in recovery after ischemic stroke.

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Abstract W P160: Elevated Lipoprotein A Levels Predict Worse Short-term Outcomes in Acute Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.wp160 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Alyana A Samai ◽

Dominique J Monlezun ◽

Amir Shaban ◽

Alexander George ◽

Janelle Cyprich ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Serum Levels ◽

Stroke Severity ◽

Short Term ◽

Poor Functional Outcome ◽

Lipoprotein A ◽

Stroke Registry ◽

History Of

Background: Lipoprotein A (Lp(a)) is a risk factor for vascular disease; however, few studies have examined the relationship between serum levels of Lp(a) and patient outcomes in acute ischemic stroke (AIS). In this study, we sought to assess whether AIS patients with elevated Lp(a) levels exhibit characteristic differences in stroke severity, in-hospital complications, and short-term outcomes as compared to patients with normal Lp(a) levels. Methods: From our prospective stroke registry, patients consecutively admitted and diagnosed with AIS 07/2008-10/2013 were included if Lp(a) levels were measured during admission. Regressions, adjusting for key covariates, analyzed outcomes in patients with elevated (+) and severely elevated (++) Lp(a) with respect to normal (-) Lp(a). The primary outcome was poor functional outcome (modified Rankin Scale > 2) on discharge. Results: Among the 1,453 patients in our stroke registry, 159 patients met our inclusion criteria; 24 patients (15.1%) were in the +Lp(a) group and 37 patients (23.3%) in the ++Lp(a) group. After adjustment for total cholesterol, LDL, HDL, and triglycerides, patients with ++Lp(a) were more than twice as likely to experience poor functional outcome (OR=2.48, 95% CI 1.0781-5.7231, p=0.033) as those with -Lp(a). Adjusting for age, NIHSS baseline, history of diabetes, admission glucose level, and tPA administration, patients with ++Lp(a) were more than 2.5 times more likely to experience poor functional outcome (OR=2.59, 95% CI 1.0129-6.6282, p=0.047) as compared to those with -Lp(a). Conclusions: Lp(a) elevation predicts higher odds of poor functional outcomes for patients with AIS compared to patients with normal levels. Our findings support the utility of Lp(a) level as a clinically useful biomarker in the development of patient risk profiles.

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Alteration of Thyroid-Related Hormones within Normal Ranges and Early Functional Outcomes in Patients with Acute Ischemic Stroke

International Journal of Endocrinology ◽

10.1155/2016/3470490 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Xiao-yan Xu ◽

Wen-yu Li ◽

Xing-yue Hu

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Thyroid Stimulating Hormone ◽

Free T4 ◽

Poor Functional Outcome ◽

Free T3 ◽

Normal Ranges

This study evaluated the prognostic value of thyroid-related hormones within normal ranges after acute ischemic stroke. This was a retrospective study and we reviewed 1072 ischemic stroke patients consecutively admitted within 72 h after symptom onset. Total triiodothyronine (T3), total thyroxine (T4), free T3, free T4, and thyroid-stimulating hormone (TSH) were assessed to determine their values for predicting functional outcome at the first follow-up clinic visits, which usually occurred 2 to 4 weeks after discharge from the hospital. 722 patients were finally included. On univariate analysis, poor functional outcome was associated with presence of atrial fibrillation as the index event. Furthermore, score of National Institutes of Health Stroke Scale (NIHSS), total T4, free T4, and C-reactive protein at admission were significantly higher in patients with poor functional outcome, whereas free T3 and total T3 were significantly lower. On multiple logistic regression analysis, lower total T3 concentrations remained independently associated with poor functional outcome [odds ratio (OR), 0.10; 95% confidence interval (CI), 0.01–0.84;P=0.035]. The only other variables independently associated with poor functional outcome were NIHSS scores. In sum, lower total T3 concentrations that were within the normal ranges were independently associated with poor short-term outcomes.

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Fibrinogen Level Predicts Prognosis of Patients with Acute Ischemic Stroke or TIA

10.21203/rs.3.rs-64098/v1 ◽

2020 ◽

Author(s):

Huiqing Hou ◽

Xianglong Xiang ◽

Yuesong Pan ◽

Hao Li ◽

Xia Meng ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Cox Regression ◽

Fibrinogen Level ◽

Stroke Recurrence ◽

Vascular Events ◽

Poor Functional Outcome ◽

Stroke Registry

Abstract Background: Fibrinogen is involved in acute stroke. This study aimed to investigate the association between fibrinogen and prognosis in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Using data from the CNSR-Ⅲ (Third China National Stroke Registry), this sub-study included 10 518 (69%) consecutive patients who had fibrinogen levels measured. The primary outcome was a poor functional outcome defined as modified Rankin Scale score of 3 to 6 within 90 days. The secondary outcomes were stroke recurrence, ischemic stroke recurrence, composite vascular events, and poor functional outcome during the 1-year follow-up and a new vascular event at 90 days. Multivariate logistic regression and Cox regression analyses were used to assess the associations between fibrinogen and prognosis of patients. Results: In total, 1446 (13.9%) patients had a poor functional outcome at 90 days. High fibrinogen levels were associated with poor functional outcome (adjusted odds ratio [OR], 1.35; 95% confidence interval [CI], 1.12-1.64) at 90 days after adjustment for confounding risk factors. High fibrinogen levels also independently predicted poor functional outcome during the 1-year follow-up. Stroke recurrence occurred in 657 (6.3%) patients at 90 days. High fibrinogen levels were associated with stroke recurrence, ischemic stroke recurrence, and composite vascular events in the crude model, but further adjustment eliminated these associations in the multivariate models. Conclusion: Our study showed that high fibrinogen level was independently associated with poor functional outcome but not with stroke recurrence in patients with acute ischemic stroke or TIA.

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Intraventricular hemorrhage clot clearance rate as an outcome predictor in patients with aneurysmal subarachnoid hemorrhage: A retrospective study

10.21203/rs.3.rs-785820/v1 ◽

2021 ◽

Author(s):

Hae Gi Park ◽

Sunghan Kim ◽

Joonho Chung ◽

Chang Ki Jang ◽

Keun Young Park ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Functional Outcome ◽

Clearance Rate ◽

Intraventricular Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Characteristic Curve ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Poor Functional Outcome

Abstract Background The development of intraventricular hemorrhage (IVH) in aneurysmal subarachnoid hemorrhage (aSAH) is linked with higher mortality and poor neurological recovery. Previous studies have investigated the effect of the amount and distribution of the initial IVH on the prognosis of aSAH. However, no studies have assessed the relationship between the changes in IVH over time and the prognosis of aSAH. The aim of this study was to analyze the effect of the clearance rate of IVH, which can be represented by the IVH clot clearance rate (CCR), on the outcomes of aSAH. Methods The IVH CCR was calculated based on the difference between the initial and follow-up modified Graeb scores (mGS), which were assessed by initial and 7-day follow-up brain computed tomography, respectively. Poor functional outcome was defined as a modified Rankin Scale score of 3–6. Univariate and multivariable analyses were performed to assess the relationships between IVH CCR and other risk factors and the prognosis of patients. Receiver operating characteristic curve analysis was performed to identify cut-off values of IVH CCR for predicting poor functional outcome. Results In total, 196 consecutive patients were diagnosed with aSAH between January 2014 and March 2018. According to the inclusion and exclusion criteria, 67 patients were finally included in the study. The univariate analysis revealed that a lower IVH CCR (p < 0.001), higher initial mGS (p < 0.001), older age (p < 0.001), higher initial Hunt and Hess grade (p < 0.001), presence of delayed infarction (p = 0.03), and presence of shunt-dependent hydrocephalus (p = 0.004) were significantly related to poor functional outcome. The multivariable analysis revealed that IVH CCR (odds ratio [OR] 0.941; p = 0.029), initial mGS (OR 1.632; p = 0.043), age (OR 1.561; p = 0.007), initial Hunt and Hess grade (OR 227.296; p = 0.030), and delayed infarction (OR 5310.632; p = 0.023) were independent predictors of poor functional outcome. Optimal cut-off values of IVH CCR and mGS for poor outcome were 36.27%, and 13.5, respectively (all p < 0.001). Conclusions The IVH CCR might have an important predictive value on poor functional outcome in patients with aSAH and IVH, along with initial mGS, age, initial Hunt and Hess grade, and delayed infarction.

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Abstract WP400: Causes of Death in a Longitudinal Analysis of Spontaneous Intracerebral Hemorrhage Survivors

Stroke ◽

10.1161/str.51.suppl_1.wp400 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Lindsey R Kuohn ◽

Audrey C Leasure ◽

Julian N Acosta ◽

Kevin N Vanent ◽

Santosh B Murthy ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Longitudinal Analysis ◽

Causes Of Death ◽

Primary Diagnosis ◽

Spontaneous Intracerebral Hemorrhage ◽

Risk Of Death ◽

History Of ◽

First Time

Introduction: With improvements in acute care, more patients are surviving a first-time spontaneous intracerebral hemorrhage (ICH). In the growing survivor population, little is known about effective secondary stroke prevention strategies or long-term causes of illness and death. This study aims to determine the cause of death in first-time ICH survivors. Methods: We performed a longitudinal analysis of prospectively collected claims data. We used data collected on all hospitalizations from California (2005-2011) and New York (2005-2014). State residents admitted with a primary diagnosis of non-traumatic ICH (ICD-9-CM code 431) who survived to discharge were included in the study. Patients were followed for a primary outcome of any readmission event resulting in death. Cause of death was defined as the primary diagnosis assigned at discharge. Kaplan-Meier survival analysis was used to estimate the risk of in-hospital death during follow-up. Cox proportional hazards and multinomial logistic regression were used to determine factors associated with the risk and cause for death. Subgroup analyses stratified by a history of atrial fibrillation (AF) were performed. Results: Of 56,593 identified ICH survivors (mean age 69 [SD 15], 49% female), 6,931 (14%) died during a median follow-up period of 3.6 years (IQR 1.5-5.9). The one-year risk of death was 7% (95% CI 7.0-7.4) and the median time to death was 0.7 years (IQR 0.1-2.3). Patients who died were older (74 vs. 68, p<0.001) and more likely to have history of AF (24% vs. 16%, p<0.001), congestive heart disease (15% vs. 8%, p<0.001), and diabetes (32% vs. 26%, p<0.001). The leading causes of death were infection (29%), recurrent ICH (12%), cardiac causes (8%), respiratory failure (7%), and ischemic stroke (4%). Patients with AF were at an increased the risk of death from ischemic stroke (OR 2.04, 95% CI 1.56-2.68, p<0.001) and cardiac causes (OR 1.49, 95% CI 1.19-1.87, p=0.002) compared to those without AF. Conclusions: The leading causes of inpatient death in ICH survivors are infection, recurrent ICH, and cardiac causes while survivors with AF are at an elevated risk for death by recurrent stroke. These findings may represent interventional targets in the effort to extend improved outcomes in ICH survivors.

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Prognostic value of myocardial MIBG scintigraphy in acute ischemic stroke

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.028 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

S Bourgeois ◽

I Peeters ◽

G Vanderschueren ◽

A Nous ◽

J De Keyser ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Univariate Analysis ◽

Washout Rate ◽

Stroke Severity ◽

Stroke Outcome ◽

Mibg Scintigraphy ◽

Poor Functional Outcome ◽

Funding Sources

Abstract Funding Acknowledgements Type of funding sources: None. Background Autonomic dysfunction is a common complication of acute ischemic stroke and has been associated with poor functional outcome and increased mortality. We investigated the potential relation between the myocardial washout rate (WOR) of 123I-meta-iodobenzylguanidine (123I-mIBG), as a measure of cardiac sympathetic activity, and functional outcome in acute ischemic stroke. Methods 38 patients with ischemic stroke (11 females, 72 years old [61-81)), underwent myocardial 123I-mIBG scintigraphy within the first week after stroke onset. Early (10 minutes post-injection (pi)) and late (4 hours pi) planar scans of the thoracic region were made. Regions of interest (ROI) were drawn over the mediastinum and the heart, and heart-to-mediastinum ratio (HMR) was calculated. Myocardial WOR was calculated as follows: (ROI heart early – ROI heart late)/ (ROI heart early) x 100%. Counts were corrected for background and counts in ROI heart late were corrected for decay. Patients were divided in 2 groups: those with a good functional outcome, defined as modified Rankin Scale (mRS) ≤ 2 at 3 months after stroke (i.e., patient is functionally independent), and those with a poor functional outcome, defined as a mRS > 2. Results Median WOR was 27,4 % (IQR 10,4-43,6). In univariate analysis, poor functional outcome after stroke was associated with age, stroke severity on admission (measured by the National Institutes of Health Stroke Scale (NIHSS)), beta-blocker use before and during hospitalization, WOR and late HMR. In subsequent multivariate analysis WOR (OR 1.087; 95% CI 1.003-1.177, p = 0.042) was an independent predictor of poor stroke outcome even after adjustment for age and NIHSS. Conclusions In patients with acute ischemic stroke, myocardial washout of 123I-mIBG predicts stroke outcome, even after adjustment for age and stroke severity on admission.

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Long term Post-Stroke Functional Outcomes: a comparison of diabetics and non-diabetics

Cerebrovascular Diseases Extra ◽

10.1159/000521442 ◽

2021 ◽

Author(s):

Deidre Anne de Silva ◽

Kaavya Narasimhalu ◽

Ian Wang Huang ◽

Fung Peng Woon ◽

John C. Allen ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Age Group ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Post Stroke ◽

The Impact

Introduction: Diabetes mellitus (DM) is known to influence outcomes in the short-term following stroke. However, the impact of DM on long-term functional outcomes after stroke is unclear. We compared functional outcomes periodically over 7 years between diabetic and non-diabetic ischemic stroke patients and investigated the impact of DM on the long-term trajectory of post-stroke functional outcomes. We also studied the influence of age on the diabetes-functional outcome association. Methods: This is a longitudinal observational cohort study of 802 acute ischemic stroke patients admitted to the Singapore General Hospital from 2005 to 2007. Functional outcomes were assessed using the modified Rankin Scale (mRS) with poor functional outcome defined as mRS≥3. Follow-up data was determined at 6 months and at median follow-up durations of 29 and 86 months. Results: Among the 802 ischemic stroke patients studied (mean age 64 ± 12 years, male 63%), 42% had DM. In regression analyses adjusting for covariates, diabetic patients were more likely to have poor functional outcomes at 6 months (OR=2.12, 95% CI: 1.23–3.67) and at median follow-up durations of 29 months (OR=1.96, 95% CI: 1.37–2.81) and 86 months (OR=2.27, 95% CI: 1.58–3.25). In addition, age modulated the effect of DM, with younger stroke patients (≤65 years) more likely to have long term poor functional outcome at the 29-month (p=0.0179) and 86-month (p=0.0144) time points. Conclusions: DM was associated with poor functional outcomes following ischemic stroke in the long term with the effect remaining consistent throughout the 7-year follow-up period. Age modified the effect of DM in the long term, with an observed increase in risk in the ≤65 age group but not in the >65 age group.

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