Cardiovascular, hematological risk factors impact mortality in pediatric ischemic stroke

Cardiovascular and hematological risk factors increased the risk for in-hospital mortality by 613% and 336%, respectively, in pediatric patients who had an ischemic stroke.

These findings, which were obtained through an analysis of a nationwide inpatient sample from 2010 to 2014, were presented at the Annual Meeting of the American Neurological Association.

While pediatric ischemic stroke (PIS) is rare, it is “one of the leading causes of morbidity and mortality in young patients,” according to the researchers.

“The prevalence of PIS increased by 35% from 1990 to 2013,” the researchers wrote. “Understanding mortality risk associated with risk factors is important.”

Nitya Beriwal

Nitya Beriwal, MBBS, of Lady Hardinge Medical School in New Delhi, and Rikinkumar S. Patel, MD, MPH, of Griffin Memorial Hospital in Oklahoma, performed a cross-sectional study of pediatric patients aged 1 to 17 years who had a primary diagnosis of ischemic stroke. The researchers stratified the sample by cardiovascular risk factors, hematological risk factors and no risk factors.

The total sample consisted of 4,036 inpatients. This included 1,321 patients with cardiovascular risk factors, 1,161 patients with hematological risk factors and 1,554 patients with no cardiovascular/hematological risk factors.

Beriwal — who presented the findings— and Patel used logistic regression to examine the effect of hematological risk factors and cardiovascular risk factors on the odds ratio (OR) association with in-hospital mortality, after controlling for demographics and potential risk factors. One limitation noted was that they did not include infants or cases of cerebral sinovenous thrombosis.

The most frequent cardiovascular risk factors in PIS included congenital abnormalities, hypertension, obesity and cardiomyopathy, according to the study findings. Prevalent hematological risk factors included systemic lupus erythematosus, sickle cell anemia, deficiency anemias and coagulation disorders.

Researchers reported a total mortality rate of 3.6%. Of this, a mortality rate of 3.1% was accounted for by individuals with hematological and cardiovascular risk factors. The individual mortality rate in the cardiovascular risk factor cohort was 57.4%; the individual mortality rate in the hematological risk factor cohort was 29.7%. When compared with no risk factors, hematological and cardiovascular risk factors correlated with four times (95% CI, 2.36-8.03) and seven times (95% CI, 4.03-12.61) greater odds for in-hospital mortality, Beriwal and Patel found.

Specifically, significant risk factors for in-hospital mortality included cardiomyopathy (OR = 15.6; 95% CI, 9.19-26.56), diabetes (OR = 11.2; 95% CI, 5.01-24.86), blood cancers (OR = 4.7; 95% CI, 2.24-10.09), hypertension (OR = 2.39; 95% CI, 1.31-4.37), coagulation disorders (OR = 2.23; 95% CI, 1.28-3.89) and deficiency anemias (OR = 1.94; 95% CI, 1.13-3.34).

“[Cardiovascular] and [hematological] risk factors increased the risk [for] in-hospital mortality in PIS by 613% and 336%, respectively,” the researchers wrote. “Strategies should be developed for effective management of potential risk factors to improve survival.”