Objective: Gastrointestinal (GI) hemorrhage is serious during the acute phase and is reported
to be related to an increased risk of death during the acute phase of acute ischemic stroke in
particular. Our study was designed to investigate the relationship between GI hemorrhage and the
mortality of acute ischemic stroke, assessing the influence of cerebrovascular risk factors, brain
herniation and oral anticoagulation on the onset of GI hemorrhage. The identified risk factors for
the occurrence of GI hemorrhage help to elucidate their respective roles in the mortality of acute
Methods: A total of 15993 consecutive patients with acute ischemic stroke, including 216 cases
and 15777 controls, were enrolled in the study from October 2010 to December 2018. Basic clinical
and examination data were collected at the time of study enrollment. GI hemorrhage was diagnosed
according to the presence of clinical features and endoscopy. Chi-square test and multiple
logistic regressions were conducted to explore the associations between the GI hemorrhage occurrence
and known risk factors. Kaplan-Meier was used to assess the influence of GI hemorrhage on
the age of mortality of acute ischemic stroke.
Results: GI hemorrhage cases among patients with acute ischemic stroke accounted for 1.35%.
Male patients with ischemic stroke were more likely to have GI hemorrhage than their female
counterparts (odds ratio (OR): 1.79; P = 0.000). Patients with atrial fibrillation (AF) had a higher
incidence of GI hemorrhage than their counterparts without AF (3.03% vs 1.20%; P < 0.05). Use
of oral anticoagulants was related to increased risk for GI hemorrhage (OR: 1.96; P = 0.00). After
adjusting for age and sex, both AF and oral anticoagulant use maintained associations with increased
risk for GI hemorrhage (2.59-times and 2.02-times risk respectively; P = 0.00). Patients
with hyperlipidemia had a lower incidence of GI hemorrhage than their counterparts without hyperlipidemia
(0.62% vs 1.60%; P < 0.05). Hyperlipidemia was associated with a reduced risk of GI
hemorrhage (OR: 0.38, 95% confidence interval (CI): 0.25-0.58; P = 0.00), even after adjusting for
age and sex (OR: 0.41; P = 0.00). Patients with brain herniation had a 6.54-times increased risk for
GI hemorrhage (P = 0.00). GI hemorrhage was associated with 10.98-fold risk for mortality of
acute ischemic stroke (P = 0.00). There was an interaction between GI hemorrhage and brain herniation
and increased 26.91-fold risk for the mortality after acute ischemic stroke (P = 0.00).
Conclusion: AF, oral anticoagulant use, brain herniation and male sex increase GI hemorrhage
risk, while hyperlipidemia reduces risk. GI hemorrhage itself increases the risk for mortality of
acute ischemic stroke. The interaction between GI hemorrhage and brain herniation increased the
risk for the mortality after acute ischemic stroke.