Cause of death in stroke
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These studies suggest the most common cause of death in stroke patients is damage to the central nervous system, influenced by factors such as brain herniation, multiple organ failure, and infections.
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Causes of Death in Stroke Patients
Stroke Mortality: Global Overview
Stroke is a significant global health issue, being the second leading cause of death and a major contributor to disability worldwide . The burden of stroke is particularly high in low- and middle-income countries (LMICs), where 86% of stroke-related deaths and 89% of disability-adjusted life years (DALYs) occur . Despite improvements in stroke prevention and treatment in high-income countries, the incidence and mortality rates remain alarmingly high in LMICs .
Primary Causes of Death in Stroke Patients
Central Nervous System-Related Causes
The leading cause of death in stroke patients is damage to the central nervous system, which includes central respiratory and circulatory failure and brain herniation. Brain herniation, in particular, is a significant risk factor, with an odds ratio (OR) of 18.15 for mortality.
Cardiovascular Complications
Cardiovascular issues are another major cause of death following a stroke. Acute stroke can disrupt central autonomic control, leading to myocardial injury, cardiac arrhythmias, and sudden death. This is especially prevalent in cases involving the insular cortex, a critical region for autonomic function. Cardiovascular comorbidities further increase the risk of mortality in stroke patients.
Hemorrhagic Stroke
Hemorrhagic strokes, although less common than ischemic strokes, are responsible for a higher proportion of sudden deaths. Primary intracerebral hemorrhage and subarachnoid hemorrhage are particularly lethal, often leading to death within hours of symptom onset. Hypertension is a significant risk factor for these types of strokes.
Risk Factors and Secondary Causes
Multiple Organ Failure and Infections
Multiple organ failure is another critical risk factor for mortality in stroke patients, with an OR of 13.12. Infections, such as community-acquired lung infections and hospital-acquired pneumonia, also contribute significantly to mortality, with ORs of 4.15 and 1.75, respectively.
Dyslipidemia and Mechanical Ventilation
Dyslipidemia and the use of mechanical ventilation are additional independent risk factors for death in stroke patients, with ORs of 4.64 and 3.37, respectively. Hypoproteinemia and a history of hypertension further exacerbate the risk.
Long-Term Mortality and Recurrent Events
Recurrent Stroke and Vascular Events
The risk of recurrent stroke and other major vascular events remains high even years after the initial stroke. In a study of Chinese adults, 41% of stroke survivors experienced a recurrent stroke within five years, and the mortality rate was 17%. The majority of recurrent strokes were of the same type as the initial stroke.
Long-Term Survival
Long-term survival rates for stroke patients are significantly lower compared to the general population. The cumulative risk of death at 28 days, one year, and five years after a first stroke is 28%, 41%, and 60%, respectively. Cardiovascular diseases are the primary cause of long-term mortality, but other factors such as cancer, accidents, and suicide also contribute.
Conclusion
The causes of death in stroke patients are multifaceted, involving central nervous system damage, cardiovascular complications, hemorrhagic events, and secondary factors like infections and organ failure. Understanding these causes and risk factors is crucial for improving prevention, treatment, and long-term management strategies to reduce stroke mortality and improve patient outcomes.
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