Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke

Objective: To evaluate the impact of neurological and medical complications on 3‐month outcomes in acute ischaemic stroke patients. Methods: We prospectively investigated complications for all the consecutive acute ischaemic stroke patients admitted within 7 days from onset in four university hospitals during a 1‐year period. Baseline data and 3‐month outcomes were collected. Poor outcome was defined as a modified Rankin Scale score 3–6. Results: A total of 1 254 patients were recruited: 264 (21.1%) and 303 (24.2%) patients experienced one or more neurological and medical complications, respectively. The most common complications were ischaemic stroke progression (17.1%) and pneumonia (12.0%). Of 1 233 patients with available 3‐month outcomes, 34.9% had a poor outcome. Multivariate analysis revealed that neurological (odds ratio, 95% confidence interval; 5.47, 3.63–8.24) and medical (3.47, 2.30–5.23) complications were independent predictors of the poor outcome. For the individual complications, ischaemic stroke progression (7.48, 4.73–11.84), symptomatic hemorrhagic transformation (3.57, 1.33–9.54), pneumonia (4.44, 2.20–8.99), extracranial bleeding (4.45, 1.88–10.53), and urinary tract infection (2.72, 1.32–5.60) were independently associated with the poor outcome. Conclusion: Outcome after ischaemic stroke is adversely influenced by complications, especially ischaemic stroke progression, symptomatic hemorrhagic transformation, pneumonia, extracranial bleeding, and urinary tract infection. Interventions to prevent those complications might improve ischaemic stroke outcome.