Infection as a Key Determinant of Readmission in Stroke Patients: A Systematic Review and Meta-Analysis
Abstract
Background: Accurately identifying the relationship between infection and the readmission of stroke patients leads to emphasis more the corresponding strategies. We aimed to determine the relationship between infection and readmission in stroke patients.
Methods: This systematic review and meta-analysis was based on PRISMA 2020 guidelines. A comprehensive search was performed across multiple databases, including PubMed, Web of Science, CINAHL, Scopus, and Google Scholar, using keywords such as "stroke," "readmission," "recurrence," "re-hospitalization," and "infection" up to 2024. The rate of readmissions due to infection, along with the Odds Ratio (OR) for infection, was calculated using a random effects model via Comprehensive Meta-Analysis V.2 software.
Results: Based on the reviewed studies, the 30-day readmission rate of stroke patients due to infection ranged from 6.5% to 30.0% and the one-year readmission rate ranged from 5.1% to 24.5%. Also, infection is an important risk factor in the readmission of stroke patients based on cohort studies (RR 1.38, 95% CI: 1.16-1.65, P<0.001), case-control (OR 1.68, 95% CI: 1.16-2.42, P= 0.006) and descriptive-analytical (OR 1.31, 95% CI: 1.07-1.59, P= 0.008).
Conclusion: The readmission rate of stroke due to infection is high and tackling infection-related readmissions in stroke patients necessitates a holistic strategy that combines clinical care, technological advancements, and education. More studies are needed in this field.
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12. Miller CM, Behrouz R (2016). Impact of infection on stroke morbidity and outcomes. Curr Neurol Neurosci Rep, 16:83.
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14. Lord AS, Lewis A, Czeisler B, Ishida K, Torres J, Kamel H, Woo D, Elkind MS, Boden-Albala B (2016). Majority of 30-Day Readmissions After Intracerebral Hemorrhage Are Related to Infections. Stroke, 47 (7):1768-71.
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17. Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT (2020). Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res, 7 (1):7.
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21. Kilkenny MF, Longworth M, Pollack M, Levi C, Cadilhac DA (2013). Factors associated with 28-day hospital readmission after stroke in Australia. Stroke, 44 (8):2260-8.
22. Nouh AM, McCormick L, Modak J, Fortunato G, Staff I (2017). High mortality among 30-day readmission after stroke: predictors and etiologies of readmission. Front Neurol, 8:632.
23. Lee HC, Chang KC, Huang YC, Hung JW, Chiu HH, Chen JJ, Lee TH (2013). Readmission, mortality, and first-year medical costs after stroke. J Chin Med Assoc, 76 (12):703-14.
24. Strowd RE, Wise SM, Umesi UN, Bishop L, Craig J, Lefkowitz D, Reynolds PS, Tegeler C, Arnan M, Duncan PW, Bushnell CD (2015). Predictors of 30-day hospital readmission following ischemic and hemorrhagic stroke. Am J Med Qual, 30 (5):441-6.
25. Bjerkreim AT, Khanevski AN, Thomassen L, Selvik HA, Waje-Andreassen U, Naess H, Logallo N (2019). Five-year readmission and mortality differ by ischemic stroke subtype. J Neurol Sci, 403:31-37.
26. Ang SH, Hwong WY, Bots ML, Sivasampu S, Abdul Aziz AF, Hoo FK (2021). Risk of 28-day readmissions among stroke patients in Malaysia (2008-2015): Trends, causes and its associated factors. PLoS One, 16 (1):e0245448.
27. Zhou LW, Lansberg MG, de Havenon A (2023). Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort. PLoS One, 18 (8):e0289640.
28. Higgins JP, Green S (2009). Cochrane handbook for systematic reviews of interventions.
29. Johnson L (2020). Infection as a predictor of readmission after stroke: A systematic review. Stroke, 51 (5):1434-1440.
30. Lee C (2021). Multidisciplinary approaches to stroke management: A systematic review. J Neurol Sci, 268 (3):962-974.
31. Smith R (2019). Impact of early mobilization on pneumonia rates in stroke patients: A randomized controlled trial. Arch Phys Med Rehabil., 100 (2):234-240.
32. White R (2022). Bundle care strategies for infection prevention. Crit Care Med, 50 (1):e45-e52.
33. Patel S (2022). The role of predictive analytics in managing stroke patients: A systematic review. Health Informatics J, 28 (1):146-158.
34. Turner A (2020). Effectiveness of staff training on infection control practices in stroke units: A meta-analysis. J Stroke Cerebrovasc Dis, 29 (9):105004.
35. Brown T (2021). Patient education for preventing infections after stroke: A randomized controlled trial. Neurorehabil Neural Repair, 35 (1):45-53.
36. White M (2023). Prophylactic antibiotics for preventing infections in stroke patients: A systematic review and meta-analysis. Clin Infect Dis, 76 (2):245-253.
2. Morton JI, Ilomäki J, Wood SJ, Bell JS, Shaw JE, Magliano DJ (2022). One-year readmission and mortality following ischaemic stroke by diabetes status, sex, and socioeconomic disadvantage: an analysis of 27,802 strokes from 2012 to 2017. J Neurol Sci, 434:120149.
3. Zhong W, Geng N, Wang P, Li Z, Cao L (2016). Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: a systematic review and meta-analysis. Neurol Sci, 37:1195-1202.
4. Bjerkreim AT, Thomassen L, Brøgger J, Waje-Andreassen U, Næss H (2015). Causes and predictors for hospital readmission after ischemic stroke. J Stroke Cerebrovasc Dis, 24 (9):2095-2101.
5. Kolmos M, Christoffersen L, Kruuse C (2021). Recurrent ischemic stroke–a systematic review and meta-analysis. J Stroke Cerebrovasc Dis, 30 (8):105935.
6. Aslanyan S, Weir CJ, Diener HC, Kaste M, Lees KR (2004). Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial. Eur J Neurol, 11 (1):49-53.
7. Miller EC, Wen T, Elkind MSV, Friedman AM, Boehme AK (2019). Infection During Delivery Hospitalization and Risk of Readmission for Postpartum Stroke. Stroke, 50 (10):2685-2691.
8. Qiu X, Xue X, Xu R, Wang J, Zhang L, Zhang L, Zhao W, He L (2021). Predictors, causes and outcome of 30-day readmission among acute ischemic stroke. Neurol Res, 43 (1):9-14.
9. Rohweder G, Salvesen Ø, Ellekjær H, Indredavik B (2017). Hospital readmission within 10 years post stroke: frequency, type and timing. BMC Neurol, 17 (1):116.
10. Xu J, Yalkun G, Wang M, Wang A, Wangqin R, Zhang X, Chen Z, Mo J, Meng X, Li H, Li Z, Wang Y (2020). Impact of Infection on the Risk of Recurrent Stroke Among Patients With Acute Ischemic Stroke. Stroke, 51 (8):2395-2403.
11. Boehme AK, Kulick ER, Canning M, Alvord T, Khaksari B, Omran S, Willey JZ, Elkind MSV (2018). Infections Increase the Risk of 30-Day Readmissions Among Stroke Survivors. Stroke, 49 (12):2999-3005.
12. Miller CM, Behrouz R (2016). Impact of infection on stroke morbidity and outcomes. Curr Neurol Neurosci Rep, 16:83.
13. Bhattacharya P, Khanal D, Madhavan R, Chaturvedi S (2011). Why do ischemic stroke and transient ischemic attack patients get readmitted? J Neurol Sci, 307 (1-2):50-4.
14. Lord AS, Lewis A, Czeisler B, Ishida K, Torres J, Kamel H, Woo D, Elkind MS, Boden-Albala B (2016). Majority of 30-Day Readmissions After Intracerebral Hemorrhage Are Related to Infections. Stroke, 47 (7):1768-71.
15. Lo CK-L, Mertz D, Loeb M (2014). Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol, 14:45.
16. Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, Stephenson M, Aromataris E (2020). Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth, 18 (10):2127-2133.
17. Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT (2020). Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res, 7 (1):7.
18. Page MJ, McKenzie JE, Bossuyt PM, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372:n71.
19. Singh A, Hussain S, Najmi AK (2017). Number of studies, heterogeneity, generalisability, and the choice of method for meta-analysis. J Neurol Sci, 381:347.
20. Borenstein M (2022). Comprehensive meta‐analysis software. Systematic reviews in health research: meta‐analysis in context:535-548.
21. Kilkenny MF, Longworth M, Pollack M, Levi C, Cadilhac DA (2013). Factors associated with 28-day hospital readmission after stroke in Australia. Stroke, 44 (8):2260-8.
22. Nouh AM, McCormick L, Modak J, Fortunato G, Staff I (2017). High mortality among 30-day readmission after stroke: predictors and etiologies of readmission. Front Neurol, 8:632.
23. Lee HC, Chang KC, Huang YC, Hung JW, Chiu HH, Chen JJ, Lee TH (2013). Readmission, mortality, and first-year medical costs after stroke. J Chin Med Assoc, 76 (12):703-14.
24. Strowd RE, Wise SM, Umesi UN, Bishop L, Craig J, Lefkowitz D, Reynolds PS, Tegeler C, Arnan M, Duncan PW, Bushnell CD (2015). Predictors of 30-day hospital readmission following ischemic and hemorrhagic stroke. Am J Med Qual, 30 (5):441-6.
25. Bjerkreim AT, Khanevski AN, Thomassen L, Selvik HA, Waje-Andreassen U, Naess H, Logallo N (2019). Five-year readmission and mortality differ by ischemic stroke subtype. J Neurol Sci, 403:31-37.
26. Ang SH, Hwong WY, Bots ML, Sivasampu S, Abdul Aziz AF, Hoo FK (2021). Risk of 28-day readmissions among stroke patients in Malaysia (2008-2015): Trends, causes and its associated factors. PLoS One, 16 (1):e0245448.
27. Zhou LW, Lansberg MG, de Havenon A (2023). Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort. PLoS One, 18 (8):e0289640.
28. Higgins JP, Green S (2009). Cochrane handbook for systematic reviews of interventions.
29. Johnson L (2020). Infection as a predictor of readmission after stroke: A systematic review. Stroke, 51 (5):1434-1440.
30. Lee C (2021). Multidisciplinary approaches to stroke management: A systematic review. J Neurol Sci, 268 (3):962-974.
31. Smith R (2019). Impact of early mobilization on pneumonia rates in stroke patients: A randomized controlled trial. Arch Phys Med Rehabil., 100 (2):234-240.
32. White R (2022). Bundle care strategies for infection prevention. Crit Care Med, 50 (1):e45-e52.
33. Patel S (2022). The role of predictive analytics in managing stroke patients: A systematic review. Health Informatics J, 28 (1):146-158.
34. Turner A (2020). Effectiveness of staff training on infection control practices in stroke units: A meta-analysis. J Stroke Cerebrovasc Dis, 29 (9):105004.
35. Brown T (2021). Patient education for preventing infections after stroke: A randomized controlled trial. Neurorehabil Neural Repair, 35 (1):45-53.
36. White M (2023). Prophylactic antibiotics for preventing infections in stroke patients: A systematic review and meta-analysis. Clin Infect Dis, 76 (2):245-253.
| Files | ||
| Issue | Vol 54 No 7 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i7.19145 | |
| Keywords | ||
| Risk factors Readmission Stroke Cerebrovascular accident Infection | ||
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How to Cite
1.
Heydari A, Mirhaghi A, Ghandehari K, Rajabpour M. Infection as a Key Determinant of Readmission in Stroke Patients: A Systematic Review and Meta-Analysis. Iran J Public Health. 2025;54(7):1389-1398.
