Acute stroke in very old people: Clinical features and predictors of in-hospital mortality

OBJECTIVES: To examine demographic characteristics, clinical features, neur oimaging data, and outcome of all acute stroke events occurring in individu als aged 85 years or older. DESIGN: Collection of data from a prospective hospital-based stroke registr y. SETTING: Between January 1986 and December 1995, the data was collected of 2,000 stroke patients admitted consecutively to the department of neurology ( having 25 beds and all acute stroke unit) of Sagrat Cor-L'Alianza Hospit al of Barcelona tan acute care, 350-bed teaching hospital serving a populat ion of approximately 250,000). PARTICIPANTS AND MEASUREMENTS: For the purpose of this study, very old pati ents (aged 85 years or older) were selected (n = 262). The data of very old stroke patients were compared with the data of patients younger than 85 ye ars of age (n = 1738). Predictors of in-hospital mortality based on clinica l and neuroimaging variables were recorded within 48 hours of stroke onset, and outcome variables (medical complications that developed during hospita lization) were assessed by multiple regression analysis. RESULTS: The very old patients showed a significantly greater frequency of atherothrombotic ( 27.5% vs 21.9%, P < .05) and cardioembolic infarctions (24.4% vs 26.3%, P < .001) and a lesser frequency of stroke of unusual cause. Acute stroke in t he very old patients was more severe than in patients younger than 85 years of age, with greater rates of in-hospital mortality (27% vs 13.5%, P(.001) , longer duration of hospital stay (22.03 +/- 29.6 vs 17.5 +/- 21.5 days, P < .001), and lesser frequency of absence of neurologic deficit at the time of hospital discharge (21.4% vs 33.1%, P < .001). Altered consciousness, l imb weakness, sensory symptoms, involvement of the parietal lobe and tempor al lobe, involvement of the internal capsule (with a protective effect), in traventricular hemorrhage, cardiac events, and respiratory events were sele cted as independent predictors of in-hospital mortality in the multivariate analysis. CONCLUSIONS: Very old patients with acute stroke showed a differential clin ical profile, different frequency of stroke subtypes, and a poorer outcome compared with stroke patients who were younger than 85 years of age. Clinic al and neuroimaging factors that are indicative of the severity of stroke a nd that were available at the time of the initial diagnosis and at the time of the development of cardiac and respiratory complications showed a predo minant influence on in-hospital mortality and may help clinicians to establ ish prognosis more accurately.