Article Text
Abstract
Objectives We tested the hypothesis that stroke outcomes in patients with preadmission use of benzodiazepine are worse.
Method In a prospective cohort study, we recruited patients with acute ischaemic stroke. Mortality, functional outcomes and cognition were evaluated at 8 and 90 days after stroke.
Results 370 patients were included. 62 (18.5%) of the 336 remaining patients were treated with benzodiazepines when stroke occurred, and they did not receive any other psychotropic drug. The mortality rate was higher in benzodiazepines users than non-users at day 8 (2.2% vs 8.1%, p=0.034) and day 90 (8.1% vs 25.9%, p=0.0001). After controlling for baseline differences using propensity-score matching, only the difference in mortality rate at day 90 was of borderline of significance, with a matched OR of 3.93 (95% CI, 0.91 to 16.98). In propensity-score-adjusted cohort, this difference remained significant with a similar treatment effect size (adjusted OR, 3.50; 95% CI, 1.57 to 7.76). A higher rate of poor functional outcome at day 8 and day 90 defined bymodified Rankin scale (mRS) ≥2 or by theBarthel index (BI) <95 was found in benzodiazepines users. In propensity-score-adjusted cohort, only the difference in mRS≥2 at day 90 remained significant (adjusted OR, 1.89; 95% CI, 1.02 to 3.48). In survivors at day 8 and at day 90, there was no significant difference in cognitive evaluation.
Conclusion Our study has shown that preadmission use of benzodiazepines could be associated with increased post-stroke mortality at 90 days. These findings do not support a putative neuroprotective effect of γ-aminobutyric acidA receptors agonists and should alert clinicians of their potential risks.
Trial registration number NCT00763217.
- stroke
- mortality
- benzodiazepines
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Footnotes
Patient consent for publication Obtained.
Contributors OC wrote the manuscript and contributed to the analysis. JL performed statistical analysis and contributed to drafting the manuscript. JD contributed to drafting the manuscript. A-MM contributed to study design and data collection. VD contributed to statistical analysis and contributed to drafting the manuscript. CC contributed to study design and data collection. DD contributed to study design, data collection and analysis. DL contributed to study design, data collection and analysis. RB contributed to study design, data collection and analysis, and drafting the manuscript. All authors read and approved the final manuscript.
Funding This study was funded by the French Ministry of Health (as part of the PHRC programme).
Competing interests None declared.
Ethics approval Comité de Protection des Personnes Nord-Ouest IV.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.