Early mortality and functional outcome after acute stroke in Uganda: prospective study with 30 day follow-up

Abstract

Identification of early outcomes post stroke and their predictors is important in stroke management strategies. We prospectively analysed 30-day outcomes (mortality and functional ability) after stroke and their predictors among patients admitted within 7 days post event to a national referral hospital in Uganda. This was a prospective study of acute stroke patients consecutively enrolled between February and July 2014. Social demographics, clinical, laboratory, imaging characteristics, outcomes (all through 30 days), time of death were assessed using standardised questionnaires. Multiple regression was used to analyse the independent influence of factors on outcomes. Of 127 patients, 88 (69.3 %) had ischemic stroke and 39 (30.7 %) had hemorrhagic stroke. Eight (6.3 %) died within 7 days, 34 (26.8 %) died within 30 days, with 2/3 of deaths occurring in hospital. Two were lost to follow up. Of 91 survivors, 49 (53.9 %) had satisfactory outcome, 42 (46.1 %) had poor functional outcome. At multivariate analysis, independent predictors of mortality at 30 days were unconsciousness (GCS <9), severe stroke at admission and elevated fasting blood sugar. None of the patients with functional independence (Barthel index ≥60) at admission died within 30 days. Inverse independent predictors of satisfactory outcome at 30 days were older age, history of hypertension and severe stroke at admission. Acute stroke patients in Uganda still have high rates of early mortality and poor functional outcomes. Independent predictors of mortality and poor functional outcome were severe stroke at admission, unconsciousness, high fasting blood sugar, old age and history of hypertension.

Marital History and Survival After Stroke

“…The research that does exist-largely from clinical studies outside of the United States and often dated-suggests that persons who are not married are more likely to die following a stroke than those who are married. [11][12][13][14] Although the evidence is limited, these findings are consistent with a large body of literature showing that individuals who are not married have fewer economic resources, less social support, more unhealthy behaviors, and ultimately worse health outcomes than their married counterparts. [15][16][17][18][19] To our knowledge, however, no existing studies have examined the association between marital status and the prospects of survival after stroke in the US population.…”

“…Whether and to what extent marital life is associated with one's prognosis after a stroke is not well documented. The research that does exist—largely from clinical studies outside of the United States and often dated—suggests that persons who are not married are more likely to die following a stroke than those who are married . Although the evidence is limited, these findings are consistent with a large body of literature showing that individuals who are not married have fewer economic resources, less social support, more unhealthy behaviors, and ultimately worse health outcomes than their married counterparts .…”

“…Mortality from all causes was the outcome for analysis. Deaths from all causes were included because many adults who experience a stroke die from related or other causes and because the majority of studies examining survival after a stroke include all‐cause mortality as the outcome . All participants in the study were followed prospectively for mortality through 2010.…”

“…Deaths from all causes were included because many adults who experience a stroke die from related or other causes 1,30 and because the majority of studies examining survival after a stroke include all-cause mortality as the outcome. 1,[11][12][13][14] All participants in the study were followed prospectively for mortality through 2010. Participants who died were identified using the National Death Index and the HRS tracking file.…”

Prognostic Value of Diffusion-Weighted Imaging (DWI) Apparent Diffusion Coefficient (ADC) in Patients with Hyperacute Cerebral Infarction Receiving rt-PA Intravenous Thrombolytic Therapy

“…Consistently, our results showed that the NIHSS score in HCI patients with good clinical outcome was obviously higher than those with poor clinical outcome. Additionally, prior stroke and severe stroke at admission were prognostic factors for poor functional outcome [31,32]. In addition, the ADC results obtained from the core and the penumbra of the infarction area are believed to be beneficial in the estimation of the infarction prognosis and in the planning of a treatment protocol in ischemic stroke patients [33].…”