Five-year mortality and related prognostic factors after inpatient stroke rehabilitation: A European multi-centre study
Liesbet De Wit, Koen Putman, Hannes Devos, Nadine Brinkmann , Eddy Dejaeger, Willy De Weerdt, Walter Jenni, Nadina Lincoln, Birgit Schuback , Wilfried Schupp, Emmanuel Lesaffre
Objective: To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation.
Design: A prospective rehabilitation-based cohort study.
Subjects: A total of 532 consecutive stroke patients from 4 European rehabilitation centres.
Methods: Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan–Meier analysis and compared across 3 BI6mths-classes (0–60, 65–90, 95–100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)).
Results: Five-year cumulative risk of death was 29.12% (95% confidence interval (CI): 22.86–35.38). Age (HR = 1.06, 95% CI: 1.04–1.09), cognitive impairment (HR = 1.77, 95% CI: 1.21–2.57), diabetes mellitus (HR = 1.68, 95% CI: 1.16–2.41) and atrial fibrillation (HR = 1.52, 95% CI: 1.08–2.14) were independent predictors of increased mortality. Hyperlipidaemia (HR = 0.66, 95% CI: 0.46–0.94), and higher BI6mths (HR = 0.98, 95% CI: 0.97–0.99) were independent predictors of decreased mortality. Five-year survival probability was 0.85 (95% CI: 0.80–0.89) for patients in BI6mths-class: 95–100, 0.72 (95% CI: 0.63–0.79) in BI6mths-class: 65–90 and 0.50 (95% CI: 0.40–0.60) in BI6mths-class: 0–60 (p < 0.0001).
Conclusion: Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival.
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