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Multicenter Study
. 2019 Feb;28(2):513-520.
doi: 10.1016/j.jstrokecerebrovasdis.2018.10.032. Epub 2018 Nov 19.

Heterotopic Ossification After Stroke: Clinical Profile and Severity of Ossification

Denise de Aquino Cunha  1 , Sarah Camargos  2 , Valéria Maria de Azeredo Passos  3 , Carla de Meirelles Mello  4 , Luiz Sérgio Vaz  5 , Luciano Romero Soares de Lima  6
Affiliations
Multicenter Study

Heterotopic Ossification After Stroke: Clinical Profile and Severity of Ossification

Denise de Aquino Cunha et al. J Stroke Cerebrovasc Dis. 2019 Feb.

Abstract

Background and purpose: The aim of this study was to evaluate heterotopic ossification (HO) prevalence after stroke, describing clinical features and investigating predictors of HO and its severity.

Methods: A cross-sectional study was carried out in 7 rehabilitation centers (Sarah Network) from 2004 to 2013.

Results: Among 17,794 stroke cases, 235 patients (1.3%) presented clinical and radiological evidence of HO. A log-binomial model with robust variance estimated the prevalence ratio of 1.3% in 10 years. A multinomial logistic regression was performed to investigate the predictors of HO and its severity. The presence of hemorrhagic stroke (prevalence ratio [PR] = 4.75; 95% confidence interval [CI] PR = 3.38; 6.68) and ischemic stroke with hemorrhagic transformation (PR = 3.08; 95% CI PR = 1.63; 5.81), male sex (PR = 1.60; 95% CI PR = 1.16; 2.22), spasticity (PR = 13.78; 95% CI PR = 8.59; 22.10), and cognitive impairment (PR = 1.88; 95% CI PR = 1.36; 2.60) were independently associated with HO. Patients with HO were younger (P < .0001) and presented a shorter time of disease (P = .013). Young adult patients were more likely to develop severe HO (odds ratio = 2.80, 95% CI 1.09; 7.20) than were elderly patients. Severe HO was also related to heavy alcohol consumption (2.45; 1.03-5.84) and involved 2 or more joints (5.34; 1.85-15.36). There was an association with use of invasive ventilation (6.30; 2.13-18.63) at the acute stroke phase and patients were dependent on activities of daily living after stroke (3.90; 1.00-15.19).

Conclusions: Despite the small prevalence of HO after stroke, this 10-year multicenter study was able to identify several associated factors related to the management and severity of stroke as well as the hemorrhagic subtype.

Keywords: Stroke; correlation; heterotopic ossification; prevalence; risk factors.

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