Predictive Clinical Factors of In-Hospital Mortality in Women Aged 85 Years or More with Acute Ischemic Stroke

Introduction: There are limited data on the outcome of acute ischemic stroke in oldest old women. We assessed clinical risk factors for in-hospital mortality in women aged 85 years or more with acute ischemic stroke. Methods: This single-center retrospective cohort study included 506 women aged ≥85 years collected from a total of 4,600 patients with acute cerebral infarction registered in an ongoing 24-year hospital stroke database. The identification of clinical risk factors for in-hospital mortality was the primary endpoint of the study. Results: The mean (± standard deviation) age of the patients was 88.6 ± 3.2 years. Stroke subtypes were cardioembolic infarcts in 37.7% of patients, atherothrombotic infarcts in 30.8%, infarcts of unknown cause and lacunar infarcts in 26.1% each, and infarcts of unusual cause in 11.5%. The in-hospital mortality rate was 20.4% (n = 103). Cardioembolic infarct accounted for 67% of all deaths (n = 69). Sudden stroke onset (OR 1.87, 95% CI 1.14–3.06), altered consciousness (OR 7.05, 95% CI 4.36–11.38), and neurological, cardiac, respiratory, and hemorrhagic events during hospitalization were independent risk factors for death, whereas lacunar infarction was a protective factor (OR 0.10, 95% CI 0.01–0.82). Conclusion: The oldest old age segment of women with acute ischemic infarction is a subgroup of stroke patients with unfavorable prognosis and high in-hospital mortality associated with sudden stroke onset, altered consciousness, and medical complications developed during hospitalization. Lacunar infarction as stroke subtype showed a favorable prognosis.

Acute cerebrovascular disease also called stroke or brain attack is a very relevant medical condition because it may have devastating consequences in terms of disability, impaired cognition, need of prolonged rehabilitation and death. Acute stroke at older age has a great impact on the ability to live independently, and the number of elderly people affected by stroke is expected to increase due to demographic projections and the aging population in industrialized countries. There are important sex-related differences with regard to the characteristics of stroke, but there are a few studies focused on women in the oldest old age segment group. This study examined clinical risk factors for early death in a large cohort of 506 women aged 85 years or more suffering from an acute ischemic stroke, the data of which were collected from an ongoing 24-year hospital stroke database. The mean age of the patients was 88.6 years. Mortality during the patients’ stay in the hospital was high. A total of 103 patients died, with a mortality rate of 20.4%. Some variables were significant predictors of mortality, including sudden onset of symptoms, altered consciousness, and the development of neurological, cardiac, respiratory, and hemorrhagic complications during hospitalization. Lacunar infarction, which is a subtype of stroke causing small-sized infarcts, was associated with a favorable prognosis. Better knowledge of the clinical features of ischemic stroke in very old women is indispensable to establish an early diagnosis and prompt effective therapy to improve the prognosis and neurological recovery of these patients.