Urinary Incontinence and Early Outcome after Acute Ischemic Stroke

Abstract

Purpose: To relate the occurrence of incontinence due to acute ischemic stroke (AIS) by demographic factors, concomitant diseases, and severity of stroke and to investigate the associations of incontinence due to stroke with early clinical outcome within the first week after event.

Materials and Methods: Of 2 659 consecutive inpatients with AIS who were admitted within 72 h of symptom onset, patients with de novo incontinence after event (n=303, m:f=131:172, age:median=74a, min=25, max=95) were analyzed in comparison to continent patients (n=1 494, m:f=877:617, age:median=67a, min=18, max=93). The occurrence of incontinence due to stroke was measured by history taking and clinical examination. The occurrence of incontinence due to stroke was analyzed in relation to concomitant diseases, medical complications occurring within the 1^st week after admission, the National Institute of Health Stroke Scale 24–36 h after admission (NIHSS), and the modified Rankin Scale at 5–7 days after admission (mRS).

Results: In patients admitted due to acute stroke age (p<0.0001), NIHSS (p<0.0001), fever prior to stroke (p=0.0070), dementia prior to stroke (p=0.0246), and female sex (p=0.0391) were associated with incontinence. A stepwise logistic regression model identified NIHSS (p<0.0001), age (p=0.0052), incontinence (p=0.0076), female sex (p=0.0128), and prior stroke (p=0.0275) as significant risk factors for a mRS≥3. As compared to continent patients these patients were significantly more affected from complications like fever (8% vs. 1.5%, p<0.0001), pneumonia (7% vs. 0.7%, p<0.0001), heart failure (6% vs. 0.5%, p<0.0001), hemorrhagic transformation of ischemic stroke (4% vs. 0.3%, p<0.0001), and urinary tract infection (4% vs. 0.5%, p<0.0007).

Conclusions: In comparison to continent patients, incontinent patients had a worse functional outcome, more early vascular complications, and infections. Higher age and stroke severity may be predisposing factors for poor functional outcome.

Zusammenfassung

Fragestellung: Ziel der vorliegenden Studie war es, den Zusammenhang zwischen Harninkontinenz nach ischämischem Insult mit demografischen Faktoren, Begleiterkrankungen und Schweregrad des Insults sowie mit der frühen klinischen Prognose (innerhalb der ersten Woche) darzustellen.

Material und Methoden: Die Studie wurde im Rahmen der Wiener Schlaganfalldatenbank durch­geführt. Patienten mit „de novo“-Inkontinenz (n=303, m:f=131:172, Alter: Median=74, Min=25, Max=95 Jahre) wurden mit kontinenten Patienten (n=1494, m:f=877:617, Alter: Median=67, Min=18, Max=93 Jahre) verglichen. Das Auftreten von Harnkontinenz wurde mittels Anamnese und klinischer Untersuchung ermittelt. Die Harninkontinenz wurde mit den inner­halb der 1. Woche nach Schlaganfall auftretenden Komplikationen und der modifizierten „Rankin Scale“ (mRS) 5–7 Tage nach Ereignis und der „National Institute of Health Stroke Scale“ (NIHSS) 24–36 Stunden nach Ereignis verglichen.

Ergebnisse: Es zeigten sich statisch signifikante Assoziationen zwischen Harninkontinenz und Alter (p<0,0001), NIHSS (p<0,0001), Fieber vor dem Ereignis (p=0,0070), der Vorerkrankung Demenz (p=0,0246) sowie dem weiblichen Ge­schlecht (p=0,0391). Die schrittweise logistische Regressionsanalyse identifizierte NIHSS (p<0,0001), Alter (p=0,0052), Inkontinenz (p=0,0076), weibliches Geschlecht (p=0,0128) und vorbestehender Schlaganfall (p=0,0275) als unabhängige Risikofaktoren für eine mRS≥3 (schwere Behinderung). Patienten mit Harninkontinenz wiesen im Vergleich zu den kontinenten Patienten folgende Komplikationen signifikant gehäuft auf: Fieber (8% vs. 1,5%, p<0,0001), Pneumonie (7% vs. 0,7%, p<0,0001), Herzinsuffizienz (6% vs. 0,5%, p<0,0001), hämorrhagischer Infarzierung (4% vs. 0,3%, p<0,0001) und Harnwegsinfekt (4% vs. 0,5%, p<0,0007).

Schlussfolgerungen: Innerhalb der ersten Woche nach ischämischem Insult sind Patienten mit Harninkontinenz häufiger von vaskulären Komplikationen und Infektionen betroffen und weisen schlechtere Werte anhand der verwendeten Skalen bezüglich der körperlichen Behinderung auf. Höheres Alter und der Schweregrad des Insults scheinen zu einem schlechteren „Early Outcome“ beizutragen.

Keywords

acute ischemic stroke - urinary incontinence - early outcome - complications

Schlüsselwörter

ischämischer Schlaganfall - Harninkontinenz - „Early Outcome“ - Komplikationen

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