Effects Of Peptic Ulcer On Prognosis And Recurrence Of Ischemic Stroke

Background and purpose:Peptic ulcer may be associated with atherosclerotic disease.Some studies showed that peptic ulcer may be a potential risk factor for ischemic stroke.It is worth noting that antiplatelet therapy in patients with a history of peptic ulcer is more likely to lead to upper gastrointestinal bleeding,which may affect the antiplatelet therapy strategy in patients with ischemic stroke.The effect of peptic ulcer on prognosis and recurrence of ischemic stroke is unclear.At present,there is no literature report on the effect of peptic ulcer on prognosis and recurrence of ischemic stroke.This study aimed to estimate the effects of peptic ulcer on the prognosis and recurrence of ischemic stroke.1)to evaluate the effect of peptic ulcer on the prognosis of neurological function of ischemic stroke;2)to evaluate the impacts of peptic ulcer on stroke recurrence;3)to evaluate the effect of peptic ulcer on death of ischemic stroke.Methods:Data on patients with first-ever ischemic stroke in the Stroke Registration system from January 2014 to May 2016 were prospectively collected.Through detailed medical history,the patients with ischemic stroke were divided into patients with history of peptic ulcer and patients without.A 1-year follow-up was conducted for all patients enrolled in the study.Follow-up endpoints included mRS Score at 90 days,recurrence of fatal and non-fatal strokes within 1 years,death in 90 days and cumulative death in 1 years.1,the Multivariate logistic regression analysis was used to identify the risk factors;2,the Kaplan-Meier method was performed in survival analysis.Cox proportional risk model was used to identify predictors for recurrence of fatal and non-fatal strokes;3,the Multiple logistic regression analysis and Cox proportional risk model were used to identify death in 90 days and cumulative death in 1 year.Results:1.A total of 2577 eligible patients were evaluated,129(5.0%)had a history of peptic ulcer.The proportion of neutrophils was higher in patients with history of peptic ulcer than those without(P=0.012).The use of proton pump inhibitors is more prevalent(35.7%vs 15.4%,P= 0.001),and the proportion of upper gastrointestinal bleeding was higher(3.9%vs 1.2%,P=0.011)in patients with history of peptic ulcer.2.The proportion of favorable outcome(mRS score<2)was higher in patients without peptic ulcer than those with(59.3%vs 42.6%,P<0.001).Multivariate logistic analysis detected that history of peptic ulcer(HR=2.89,95%CI?1.03-8.10,P=0.043),NIHSS score(HR=2.11,95%CI,1.79-2.48,P<0.001),and large-artery atherosclerosis stroke subtype(HR=4.08,95%CI,1.11-15.03,P=0.035)decreased the likelihood of favorable outcomes.3.Patients have a higher recurrence rate of fatal and non-fatal strokes with ischemic stroke with a history of peptic ulcer than those without during the 1-year follow-up(12.4%vs 7.2%,P=0.030).Cox proportional hazard model showed old age(HR=1.018,95%CI,1.005-1031,P=0.008),hypertension(HR = 1.397,95%CI,1.017-1.918,P=0.039),History of peptic ulcer(HR=1.853,95%CI,1.111-3.091,P=0.018)was associated with stroke recurrence;4.The mortality at 90 days(5.4%vs 1.6%,P=0.001)and cumulative death in 1 years(9.3%vs 4.6%,P=0.016)were higher in patients with a history of peptic ulcer than those without.The univariate analysis showed that the history of peptic ulcer(OR=3.115,95%CI,1.262-7.689,P=0.014)was a risk factor for death at 90 days,but there was no significantly statistical difference from cumulative death in 1 years(OR=1.621,95%CI,0.842-3.122,P=0.148),Conclusion:1.Peptic ulcer may reduce the chance of good functional prognosis in first-ever ischemic stroke patients at 90 days after admission.2.Peptic ulcer may increase the risk of stroke recurrence in first-ever ischemic stroke patients.3.Peptic ulcer may increase the death of patients with first-ever ischemic stroke at 90 days,but not is the risk factor for cumulative death in 1 year after admission.The results emphasize the importance of appropriate prevention and management of peptic ulcer for ischemic stroke.