Thrombocytopenia and in-hospital mortality risk among ischemic stroke patients

Jason J. Sico, Michael S. Phipps, John Concato, Carolyn K. Wells, Albert C. Lo, Steven E. Nadeau, Linda S. Williams, Aldo J. Peixoto, Mark Gorman, John L. Boice, Dawn M. Bravata

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Thrombocytopenia has been associated with increased mortality in nonstroke conditions. Because its role in acute ischemic stroke is less well understood, we sought to determine whether thrombocytopenia at admission for acute ischemic stroke was associated with in-hospital mortality. Methods: We used data from a retrospective cohort of stroke patients (1998-2003) at 5 U.S. hospitals. Risk factors considered included conditions that can lead to thrombocytopenia (e.g., liver disease), increase bleeding risk (e.g., hemophilia), medications with antiplatelet effects (e.g., aspirin), and known predictors of mortality (e.g., National Institutes of Health Stroke Scale and Charlson Comorbidity Index scores). Logistic regression modeling evaluated the adjusted association between thrombocytopenia, defined as platelets <100,000/μL, and in-hospital mortality. Results: Among 1233 acute ischemic stroke patients, thrombocytopenia was present in 2.3% (n = 28). A total of 6.1% (n = 75) of patients died in the hospital. In unadjusted analyses, thrombocytopenia was associated with higher mortality (8/28 [28.6%] v 67/1205 [5.6%]; P <.0001). Thrombocytopenia was also independently associated with in-hospital mortality after adjustment for National Institutes of Health Stroke Scale score and comorbidities, with an odds ratio of 6.6 (95% confidence interval 2.3-18.6). Conclusions: Admission thrombocytopenia among patients presenting with acute ischemic stroke predicts in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)e99-e102
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number7
DOIs
StatePublished - Oct 1 2013

Fingerprint

Hospital Mortality
Thrombocytopenia
Stroke
National Institutes of Health (U.S.)
Mortality
Comorbidity
Hemophilia A
Aspirin
Liver Diseases
Blood Platelets
Logistic Models
Odds Ratio
Confidence Intervals
Hemorrhage

Keywords

  • Acute ischemic stroke
  • medical comorbidity
  • mortality
  • thrombocytopenia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

Thrombocytopenia and in-hospital mortality risk among ischemic stroke patients. / Sico, Jason J.; Phipps, Michael S.; Concato, John; Wells, Carolyn K.; Lo, Albert C.; Nadeau, Steven E.; Williams, Linda S.; Peixoto, Aldo J.; Gorman, Mark; Boice, John L.; Bravata, Dawn M.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 7, 01.10.2013, p. e99-e102.

Research output: Contribution to journalArticle

Sico, JJ, Phipps, MS, Concato, J, Wells, CK, Lo, AC, Nadeau, SE, Williams, LS, Peixoto, AJ, Gorman, M, Boice, JL & Bravata, DM 2013, 'Thrombocytopenia and in-hospital mortality risk among ischemic stroke patients', Journal of Stroke and Cerebrovascular Diseases, vol. 22, no. 7, pp. e99-e102. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.08.005
Sico, Jason J. ; Phipps, Michael S. ; Concato, John ; Wells, Carolyn K. ; Lo, Albert C. ; Nadeau, Steven E. ; Williams, Linda S. ; Peixoto, Aldo J. ; Gorman, Mark ; Boice, John L. ; Bravata, Dawn M. / Thrombocytopenia and in-hospital mortality risk among ischemic stroke patients. In: Journal of Stroke and Cerebrovascular Diseases. 2013 ; Vol. 22, No. 7. pp. e99-e102.
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abstract = "Background: Thrombocytopenia has been associated with increased mortality in nonstroke conditions. Because its role in acute ischemic stroke is less well understood, we sought to determine whether thrombocytopenia at admission for acute ischemic stroke was associated with in-hospital mortality. Methods: We used data from a retrospective cohort of stroke patients (1998-2003) at 5 U.S. hospitals. Risk factors considered included conditions that can lead to thrombocytopenia (e.g., liver disease), increase bleeding risk (e.g., hemophilia), medications with antiplatelet effects (e.g., aspirin), and known predictors of mortality (e.g., National Institutes of Health Stroke Scale and Charlson Comorbidity Index scores). Logistic regression modeling evaluated the adjusted association between thrombocytopenia, defined as platelets <100,000/μL, and in-hospital mortality. Results: Among 1233 acute ischemic stroke patients, thrombocytopenia was present in 2.3{\%} (n = 28). A total of 6.1{\%} (n = 75) of patients died in the hospital. In unadjusted analyses, thrombocytopenia was associated with higher mortality (8/28 [28.6{\%}] v 67/1205 [5.6{\%}]; P <.0001). Thrombocytopenia was also independently associated with in-hospital mortality after adjustment for National Institutes of Health Stroke Scale score and comorbidities, with an odds ratio of 6.6 (95{\%} confidence interval 2.3-18.6). Conclusions: Admission thrombocytopenia among patients presenting with acute ischemic stroke predicts in-hospital mortality.",
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AU - Phipps, Michael S.

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AU - Lo, Albert C.

AU - Nadeau, Steven E.

AU - Williams, Linda S.

AU - Peixoto, Aldo J.

AU - Gorman, Mark

AU - Boice, John L.

AU - Bravata, Dawn M.

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N2 - Background: Thrombocytopenia has been associated with increased mortality in nonstroke conditions. Because its role in acute ischemic stroke is less well understood, we sought to determine whether thrombocytopenia at admission for acute ischemic stroke was associated with in-hospital mortality. Methods: We used data from a retrospective cohort of stroke patients (1998-2003) at 5 U.S. hospitals. Risk factors considered included conditions that can lead to thrombocytopenia (e.g., liver disease), increase bleeding risk (e.g., hemophilia), medications with antiplatelet effects (e.g., aspirin), and known predictors of mortality (e.g., National Institutes of Health Stroke Scale and Charlson Comorbidity Index scores). Logistic regression modeling evaluated the adjusted association between thrombocytopenia, defined as platelets <100,000/μL, and in-hospital mortality. Results: Among 1233 acute ischemic stroke patients, thrombocytopenia was present in 2.3% (n = 28). A total of 6.1% (n = 75) of patients died in the hospital. In unadjusted analyses, thrombocytopenia was associated with higher mortality (8/28 [28.6%] v 67/1205 [5.6%]; P <.0001). Thrombocytopenia was also independently associated with in-hospital mortality after adjustment for National Institutes of Health Stroke Scale score and comorbidities, with an odds ratio of 6.6 (95% confidence interval 2.3-18.6). Conclusions: Admission thrombocytopenia among patients presenting with acute ischemic stroke predicts in-hospital mortality.

AB - Background: Thrombocytopenia has been associated with increased mortality in nonstroke conditions. Because its role in acute ischemic stroke is less well understood, we sought to determine whether thrombocytopenia at admission for acute ischemic stroke was associated with in-hospital mortality. Methods: We used data from a retrospective cohort of stroke patients (1998-2003) at 5 U.S. hospitals. Risk factors considered included conditions that can lead to thrombocytopenia (e.g., liver disease), increase bleeding risk (e.g., hemophilia), medications with antiplatelet effects (e.g., aspirin), and known predictors of mortality (e.g., National Institutes of Health Stroke Scale and Charlson Comorbidity Index scores). Logistic regression modeling evaluated the adjusted association between thrombocytopenia, defined as platelets <100,000/μL, and in-hospital mortality. Results: Among 1233 acute ischemic stroke patients, thrombocytopenia was present in 2.3% (n = 28). A total of 6.1% (n = 75) of patients died in the hospital. In unadjusted analyses, thrombocytopenia was associated with higher mortality (8/28 [28.6%] v 67/1205 [5.6%]; P <.0001). Thrombocytopenia was also independently associated with in-hospital mortality after adjustment for National Institutes of Health Stroke Scale score and comorbidities, with an odds ratio of 6.6 (95% confidence interval 2.3-18.6). Conclusions: Admission thrombocytopenia among patients presenting with acute ischemic stroke predicts in-hospital mortality.

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