Clinical study Epidemiologic features and risk factors of sepsis in ischemic stroke patients admitted to intensive care: A prospective cohort study Yahia Zaid a , Abbas Rajeh b , Saeed Hosseini Teshnizi c , Ali Alqarn d , Firoozeh Tarkesh e , Zahra Esmaeilinezhad e , Reza Nikandish e,⇑ a Emergency Medicine Department, Nemazee Hospital, Shiraz, Iran b Emergency Medicine Department, Rajaee Hospital, Shiraz, Iran c Paramedical School, Hormozgan University of Medical Science, Bandar-Abbas, Iran d Neurology Medicine Department, Nemazee Hospital, Shiraz, Iran e Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran article info Article history: Received 22 April 2019 Accepted 6 July 2019 Keywords: Epidemiologic features Sepsis Ischemic stroke Intensive care unit abstract Background/objective: Stroke is the second leading cause of death globally that predisposed to sepsis. Therefore, this study was aimed to assess the risk factors and epidemiologic features of sepsis in ischemic stroke patients admitted to ICUs. Methods: Throughout this prospective study, we investigated all severe ischemic stroke patients admit- ted to ICUs of Namazi and Ali-Ashghar Hospitals in Shiraz. After ICU admission and diagnosing stroke by a neurologist according to NIHSS (National Institute of Health Stroke Scale) criteria, sepsis work-up was performed in all patients suspected to have sepsis. Then the incidence of sepsis and its risk factors in ICU admitted stroke patients were determined. Results: A total of 149 patients were screened in this study. The mean age of the participants was 65.37 ± 15.40 years old and 57.4% of them were male. Hypertension was the most common coexistent disease (74.6%) in stroke patients. Seventy-six patients (62.3%) were diagnosed with sepsis and pneumo- nia was the most common infection leading to sepsis in stroke patients. Our data showed significant dif- ferences between two groups in terms of APACHE-IV score (P < 0.001), NIHSS and APS (P < 0.001) before ICU admission (P < 0.001) and NIHSS at admission (P < 0.001); however, age (P = 0.07) and sex (P = 0.17) were not significantly different between the groups. Logistic regression analysis displayed that severe stroke (NIHSS = 21–42, OR = 49.09) and severe loss of consciousness (GCS < 8, OR = 27.95) at admission were the most essential predictive factors for sepsis after ischemic stroke. Conclusions: This study showed that ICU patients with severe ischemic stroke were more susceptible to sepsis during the hospital course. Ó 2019 Published by Elsevier Ltd. 1. Introduction Cerebrovascular disease or stroke is the second leading cause of death globally. Over 85% of stroke deaths occur in the developing countries which are becoming a major health issue [1,2]. The reported stroke incidence in Iran is almost forty-three patients per 100,000 of pop- ulation. Cardioembolism is considered as one of the main etiolo- gies which is responsible for 10–40% of strokes in young patients [3]. Due to severity of stroke, possessing a poor prognosis and being susceptible to lots of complications, these patients have need for intensive care unit (ICU) support. Post-stroke infections are among the most significant complications that are considered as indepen- dent and fixed risk factors for adverse outcomes apart from pro- longed hospital stay. These infections are partly related to the induced immunosuppression by the cerebral damage. Infection rates are about 33% in cerebral ischemia and 58% in intracerebral hemorrhages that the respiratory and urinary tract are the most common sources [4,5]. Sepsis is a potentially fatal reaction of the host to a bacterial or fungal infection and its incidence in general ICUs ranges from 17.3 to 37%. Late treatment of sepsis might develop to intravascular vol- ume depletion, cellular hypoxia, organ failure or death; however, https://doi.org/10.1016/j.jocn.2019.07.031 0967-5868/Ó 2019 Published by Elsevier Ltd. ⇑ Corresponding author. E-mail address: nikandishr@sums.ac.ir (R. Nikandish). Journal of Clinical Neuroscience 69 (2019) 245–249 Contents lists available at ScienceDirect Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn