BERKELEY, CA (UroToday.com) - When the same subjects, who were treated in the previous report,[1] were divided into patients with UI on arrival (UI group, n=60) and those without UI (Control group, n=177), there were no significant differences between the two groups concerning the sex ratio, systolic blood pressure, temperature, ratio of hypertension, diabetes mellitus and duration of hospitalization (Table 1). However, the average age, ratio of hemorrhagic stroke, average heart rate, and ratio of patients with a previous stroke, in the UI group, was significantly higher than in the Control group.
The GCS upon admission, in the UI group, was significantly lower than that in the Control group. Concerning the outcome, the average modified Rankin scale and mortality rate in the UI group was significantly higher than those in the Control group. After excluding the mortal case, the modified Rankin scale in the UI group remained significantly higher (mean 3.5 +/- 0.1 vs. 2.0 +/- 0.0), and the duration of hospitalization was significantly longer than those in the control group (65.3 +/- 6.9 vs. 48.4 +/- 3.7 days, p < 0.05). As the level of consciousness and age were previously reported to be prognostic factors among the patients with stroke,[2, 3, 4, 5] I performed a subanalysis by excluding subjects with a GCS under 14 and an age over 80 years (UI group: n=12, Control: n=129). The mortality rate (0% vs. 1%) and factors other than the modified Rankin scale between the two groups were not significantly different. The modified Rankin scale (Mean 3.1 +/- 0.3 vs.1.8 +/- 0.1) in the UI group was still significantly higher than that in the Control group.
This study also demonstrated that the presence of UI upon arrival among patients with stroke was an important prognostic factor, even in conscious patients.
Table 1. Results of the analysis
| Urinary Incontinence |
Control |
p-value |
|
|
(n=60) |
(n=177) |
||
|
Age |
70.5 +/- 1.4 |
64.9 ±0.9 |
< 0.01 |
|
Sex (Male/Female) |
31/29 |
103/74 |
n.s. |
|
Stroke type |
< 0.05 | ||
|
Subarachnoid hemorrhage |
14 (23.3%) |
23 (12.9%) |
|
|
Intracerebral hemorrhage |
23 (38.3%) |
49 (27.6%) |
|
|
Ischemia |
23 (38.3%) |
105 (59.3%) |
|
|
Vital signs on arrival |
|||
|
Glasgow Coma Scale |
9.5 +/- 0.5 |
13.8 +/- 0.2 |
< 0.0001 |
|
Systolic blood pressure (mmHg) |
166.8 +/- 5.0 |
165.1 +/- 2.2 |
n.s. |
|
Heart rate (/minute) |
83.0 +/- 2.8 |
77.7 +/- 1.0 |
< 0.05 |
|
Temperature (℃) |
36.3 +/- 0.0 |
36.4 +/- 0.0 |
n.s. |
|
Past history |
|||
|
Hypertension |
31 (51.6%) |
106 (59.8%) |
n.s. |
|
Diabetes mellitus |
16 (26.6%) |
38 (21.4%) |
n.s. |
|
Stroke |
16 (26.6%) |
16 (9.0%) |
< 0.01 |
|
Duration of admission (days) |
53.3 +/- 6.2 |
47.9 +/- 3.7 |
n.s. |
|
Modified Rankin Scale |
4.0 +/- 0.2 |
2.1 +/- 0.1 |
< 0.0001 |
|
Mortality rate |
12 (20%) |
7 (3.9%) |
< 0.001 |
n.s.: not significant
mean +/- standard error
References:
- Yanagawa Y, Yoshihara T, Kato H, Iba T, Tanaka H. Significance of urinary incontinence, age, and consciousness level on arrival among patients with stroke. J Emerg Trauma Shock. 2013;6:83-6.
- Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ. Predicting disability in stroke--a critical review of the literature. Age Ageing 1996;25:479-89.
- Lee AH, Somerford PJ, Yau KK. Factors influencing survival after stroke in Western Australia. Med J Aust 2003;179:289-93.
- Han DS, Pan SL, Chen SY, Lie SK, Lien IN, Wang TG. Predictors of long-term survival after stroke in Taiwan. J Rehabil Med 2008;40:844-9.
- Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD, Giroud M, Rudd A, Ghetti A, Inzitari D; European BIOMED Study of Stroke Care Group. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke 2003;34:1114-9.
Written by:
Youichi Yanagawa, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
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