New-onset constipation after stroke: incidence, risk factors and impact on the prognosis of stroke / 中国神经精神疾病杂志

ABSTRACT

Background Constipation is a common complication after stroke, and the results investigated overseas showed the incidence was about 30% ～60%. The difference of results is so significant because the time investigated and the diagnosis criterion used are different. There are less relative report about risk factors of constipation and no report about the impact of constipation on pragnosis. The study is to investigate the incidence and risk factors of new-onset constipation after stroke in the patients with acute stroke and to evaluate the impact of new-onset constipation occurrence on the prognosis in the patients.Methods A prospective cohort study of new-onset constipation was performed to investigate 154 cases of acute stroke patients who were hospitalized from December 2003 to October 2004 in the department of neurology, the first Affiliated Hospital of Sun Yat-sen University. We recorded the demographics, medical history,stroke severity and medication used. National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI)and Modified Rankin Scale (MRS) were evaluated in the 1st week and 4th week after stroke to evaluate the neurological function and ability of an independent life. BI and MRS were recorded at the 12th week after stroke.Patients were then followed for the development of stroke, the event such as recurrence or death. Constipation was defined by Rome Ⅱ criteria.Results The incidence of new-onset constipation after stroke within 4 weeks was 55. 31%, and the highest risk was within seven days after onset of stroke. Cox regression showed that the incidence of constipation occurrence was strongly related to neurological functional status of patients in the 1st week assessed by BI and the transform of surrounding for defecation. In the 4th week and 12th week after stroke, the rates of poor prognosis in patients with constipation in middling state were both higher than patients without constipation, and the difference was statistically significant respectively(P ＜ 0. 01 ;P = 0. 012).Conclusions The new-onset constipation occurrence in acute stroke is very common and its main risk factor is functional status assessed by Barthel Index at the 1st week after onset and the transform of surrounding for defecation. The results indicate that the new-onset constipation occurrence after stroke has negative effects on the outcome of partial stroke patients.