MEDICAL AND NEUROLOGICAL COMPLICATIONS OF ISCHEMIC STROKE - EXPERIENCE FROM THE RANTTAS TRIAL

Background and Purpose-Medical and neurological complications after ac ute ischemic stroke may adversely impact outcome and in some cases may be preventable. Limited data exist regarding the frequency of such co mplications occurring in the first days after the ictus and the relati onship of these complications to outcome. Our objective was to identif y the types, severity, and frequency of medical and neurological compl ications following acute ischemic stroke and to determine their role i n mortality and functional outcome. Methods-Rates of serious (life-thr eatening) and nonserious medical and neurological complications and mo rtality were derived from the placebo limb of the Randomized Trial of Tirilazad Mesylate in Acute Stroke (RANTTAS) database (n=279). Complic ations were correlated with clinical outcome using logistic regression techniques. Results-Of all patients, 95% had at least one complicatio n. The most common serious medical complication was pneumonia (5%), an d the most common serious neurological complication was new cerebral i nfraction or extension of the admission infarction (5%). The 3-month m ortality was 14%; 51% of these deaths were attributed primarily to med ical complications. Outcome was significantly worse in patients with s erious medical complications, after adjustment for baseline imbalances , as measured by the Barthel Index (odds ratio [OR], 6.1; 95% confiden ce interval [CT], 2.5 to 15.1) and by the Glasgow Outcome Scale (OR, 1 1.6; 95% CI, 4.3 to 30.9). After death was discounted, serious medical complications were associated with severe disability at 3 months as d etermined by the Glasgow Outcome Scale (OR, 4.4; 95% CI, 1.3 to 14.8). Conclusions-Medical complications that follow ischemic stroke not onl y influence mortality but may influence functional outcome.