Risk factors for in-hospital and follow-up mortality after childhood arterial ischemic stroke

Objectives: To explore risk factors contributing to 30-day and long-term survival in children with a first episode of arterial ischemic stroke (AIS).

Study design: Single center prospective observational study including 119 children aged between 30 days and 18 years, with a first episode of AIS between 2003 and 2015. Diagnosis was confirmed with magnetic resonance images. Outcomes included 30-day mortality and survival up to 8 years of follow-up. Demographic (e.g., gender, age), clinical (e.g., stroke severity measured by the Pediatric National Institute of Health Stroke Scale (NIHSS), clinical presentation, underlying conditions), radiological (e.g., involved circulation, location), and stroke recurrence data, were used to predict outcomes. Data analyses included logistic and Cox regression multivariate models with Firth's bias correction.

Results: 30-day mortality was 11.7% (n = 14). A total of 23 (19.3%) children died during the follow-up. 30-day mortality was only predicted by stroke severity (OR = 1.11, 95% CI = 1.02-1.26) in children > 2 years. Survival was predicted by stroke severity (HR = 1.05, 95% CI = 1.01-1.09), congenital heart disease (HR = 3.62, 95% CI = 1.33-10.93), prothrombotic states (HR = 3.51, 95% CI = 1.25-9.32), and anterior plus posterior circulation stroke (HR = 2.43, 95% CI = 1.42-4.61, p 0.026). Stroke recurrence (n= 23; 19.3%) was not a significant predictor of follow-up mortality.

Conclusions: This study identified groups with greater acute and long-term mortality after a first episode of AIS in childhood. Specific interventions focused on these risk groups may decrease mortality rates. Further studies need to confirm our findings by adding children from other centers.