Logistic regression analyses^* showing effects of in-hospital managements on the annual decrease in in-hospital mortality.

<p>* All models were adjusted for age, sex, stroke severity on admission indicated by Rankin Scale, sum of comorbidities, year of admission, and separately for different in-hospital managements.</p><p>^‡ Includes intravenous and intra-arterial thrombolysis. Models including thrombolysis considered the time period 2000–2008, models including antiplatelets considered the time period 2000–2002 and 2007–2008, models including antihypertensive therapy, antidiabetic, and statins considered the time period 2003–2008, models including anticoagulants and physiotherapy considered the time period 2000–2008, modes including admission to Stroke Unit considered the time period 2000–2006.</p><p>Abbreviations: aOR, adjusted odds ratio; CI, confidence interval</p><p>Logistic regression analyses^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131473#t003fn001" target="_blank">*</a>} showing effects of in-hospital managements on the annual decrease in in-hospital mortality.</p

Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke

<div><p>Background</p><p>Mortality from ischemic stroke has declined over time. However, little is known about the reasons for the decreased mortality. We therefore aimed to evaluate trends in in-hospital mortality and to identify factors associated with these trends.</p><p>Methods</p><p>This study was based on a prospective database of 26 hospitals of the Stroke Register of Northwestern Germany, which included 73,614 patients admitted between 2000 and 2011. Time trends in observed (crude) and risk-adjusted in-hospital mortality were assessed. Independent factors associated with death after stroke were evaluated using multivariable logistic regression analysis.</p><p>Results</p><p>The observed in-hospital mortality decreased from 6.6% in 2000 to 4.6% in 2008 (P < 0.001 for trend) and then remained fairly stable. The risk-adjusted mortality decreased from 2.85% in 2000 to 1.86% in 2008 (P < 0.01 for trend) and then increased to 2.32% in 2011. Use of in-hospital treatments including antiplatelets within 48 hours, antihypertensive therapy, statins, antidiabetics, physiotherapy and anticoagulants increased over time and was significantly associated with a decrease in mortality. The association of the year of admission with mortality became insignificant after adjustment for antiplatelet therapy within 48 hours (from OR 0.96; 95% CI, 0.94-0.98, to OR 0.99; 95% CI, 0.97-1.01) and physiotherapy (from OR 0.96; 95% CI, 0.94-0.97, to OR 0.99; 95% CI, 0.97-1.00).</p><p>Conclusions</p><p>In-hospital mortality decreased by approximately one third between 2000 and 2008. This decline was paralleled by improvements in different in-hospital managements, and we demonstrated that it was partly mediated by early antiplatelet therapy and physiotherapy use.</p></div

Baseline characteristics of patients with ischemic stroke from 2000 to 2011.

<p>Baseline characteristics of patients with ischemic stroke from 2000 to 2011.</p

In-hospital management of patients with stroke from 2000 to 2011.

<p>^‡ Includes intravenous and intra-arterial thrombolysis.</p><p>Percentages are related to available informations and therefore sum to 100%. Blank cells indicate data not available. Data missing rate: for admission ward 7.9%.</p><p>In-hospital management of patients with stroke from 2000 to 2011.</p

In-hospital mortality among patients with ischemic stroke between 2000 and 2011.

<p>A, Observed (crude) mortality. B, Risk-adjusted mortality was determined with the use of logistic regression models to adjust for age, sex, initial stroke severity, and the number of comorbidities.</p

The distribution of infarctions for patients with (AHI > 10) and without (AHI < 10) SRBD.

<p>Blue shades: less frequent infarcted regions; Red shades: more frequent infarcted regions. Brainstem infarcts appear to be more frequent in patients with SRBD (arrow, not significant).</p

Baseline characteristics of patients with and without sleep related breathing disorder (SRBD).

<p>Baseline characteristics of patients with and without sleep related breathing disorder (SRBD).</p