Kara Jo Swafford, MD

Shao IY, Elkind MSV, Boehme AK. Risk Factors for Stroke in Patients With Sepsis and Bloodstream Infections. Stroke. 2019;50:1046–1051.

Sepsis is associated with increased risk for stroke; however, the mechanisms remain unknown. Shao et al performed a retrospective review of a California inpatient database to identify patients at greatest risk of stroke within 1 year of hospitalization for sepsis. Stroke occurred rarely in this patient population, with 0.5% having either an ischemic or hemorrhagic stroke within the first year. Risk factors more prevalent in patients with stroke post-sepsis were valvular heart disease, renal failure, congestive heart failure, coagulopathy, peripheral vascular diseases, pulmonary circulation disorders, and lymphoma.

Based on an adjusted multivariable logistic model including these risk factors as covariates, a composite risk score was developed by assigning an integer to each risk factor based on the odds ratios. Absolute risk of stroke increased as the composite risk score increased. For each point increase in the score, odds of stroke were slightly higher for patients 18-45 years of age when compared to patients older than 45 years. For all groups, risk of stroke was highest in those with coagulopathy (coagulopathy included antithrombotic coagulation defects, qualitative platelet defects, and thrombocytopenia).

Because this study was a retrospective review of an inpatient database, the authors did not have access to specific clinical patient information, such as antithrombotic use, which may have led to biased risk estimate in patients with a coagulopathy. The observed negative association between age greater than 65 years and hemorrhagic stroke post-sepsis could be related to survivor bias. This study provides a quantifiable risk score that may offer guidance in patient management. It also provides implications for further investigation on the link between sepsis and stroke, possibly providing clinical strategies for stroke prevention in post-sepsis patients.