Infecciones del tracto urinario podrían ser desencadenantes de ictus

Infection as a Stroke Trigger

Associations Between Different Organ System Infection Admissions and Stroke Subtypes

Abstract

Background and Purpose—

The relationships between different infection types and stroke subtype are not well-characterized. We examined exposure to infections in different organ systems in different time periods before the acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage.

Methods—

We used the New York State Inpatient Databases and Emergency Department Databases (2006–2013). Validated International Classification of Diseases, Ninth Edition definitions identified index hospitalizations for acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, and emergency department visits and hospitalizations for infection (skin, urinary tract infection, septicemia, abdominal, and respiratory). We used case cross-over analysis with conditional logistic regression to estimate odds ratios (OR) for the association between each infection type during case periods compared with control periods 1 year before.

Results—

Every infection type was associated with an increased likelihood of acute ischemic stroke. The greatest association was for urinary tract infection, with OR of 5.32 (95% CI, 3.69–7.68) within the 7-day window. The magnitude of association between urinary tract infection and intracerebral hemorrhage was of lesser magnitude, with OR of 1.80 (1.04–3.11) in the 14-day exposure period and OR of 1.54 (1.23–1.94) in the 120-day exposure period. Only respiratory infection was associated with subarachnoid hemorrhage, with OR of 3.67 (1.49–9.04) in the 14-day window and 1.95 (1.44–2.64) in the 120-day window.

Conclusions—

All infection types were associated with subsequent acute ischemic stroke, with the greatest association for urinary tract infection. Stroke triggers are conditions that precipitate the acute occurrence of stroke. Acute infections have been studied as potential triggers of stroke.1–3 However, infections in different organ systems have been rarely examined comparatively in the same study, and studies failed to differentiate subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH).2 We sought to examine the differential associations between infection in different body systems and risk of stroke (ischemic, SAH, and ICH), hypothesizing that there would be a gradient of association, with a greater magnitude of association between infection and stroke during shorter time intervals before the stroke event.