TY - JOUR
T1 - Prognostic significance of early urinary catheterization after acute stroke
T2 - Secondary analyses of the international HeadPoST trial
AU - Ouyang, Menglu
AU - Billot, Laurent
AU - Song, Lili
AU - Wang, Xia
AU - Roffe, Christine
AU - Arima, Hisatomi
AU - Lavados, Pablo M.
AU - Hackett, Maree L.
AU - Olavarría, Verónica V.
AU - Muñoz-Venturelli, Paula
AU - Middleton, Sandy
AU - Pontes-Neto, Octavio M.
AU - Lee, Tsong Hai
AU - Watkins, Caroline L.
AU - Robinson, Thompson G.
AU - Anderson, Craig S.
N1 - Publisher Copyright:
© 2020 World Stroke Organization.
PY - 2021/2
Y1 - 2021/2
N2 - Background: An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST). Methods: Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as “poor outcome,” scores 3–6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates. Results: Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13–1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59–2.18). The number exposed to IUC for poor outcome was 13. Conclusions: IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.
AB - Background: An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST). Methods: Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as “poor outcome,” scores 3–6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates. Results: Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13–1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59–2.18). The number exposed to IUC for poor outcome was 13. Conclusions: IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.
KW - Urinary catheter
KW - acute stroke
KW - clinical trial
KW - disability
KW - urinary tract infection
UR - http://www.scopus.com/inward/record.url?scp=85081594816&partnerID=8YFLogxK
U2 - 10.1177/1747493020908140
DO - 10.1177/1747493020908140
M3 - 文章
C2 - 32075569
AN - SCOPUS:85081594816
SN - 1747-4930
VL - 16
SP - 200
EP - 206
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 2
ER -