Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke

Abstract

Objective. To identify the risk factors, etiologies, length of stay, severity, and predictors of disability among patients with the first ischemic stroke in Jordan. Methods. A retrospective cohort study of 142 patients who were admitted to the Neurology Department at King Abdullah University Hospital between July/2017 and March/2018 with a first ischemic stroke. Etiology was classified according to the TOAST criteria. Severity was represented by NIHSS score, disability by mRS score, and prolonged length of stay as hospitalizations more than 75th percentile of the cohort’s median length of stay. Analysis of the sample demographics and descriptive statistics were done, including frequencies of prevalence of independent variables (risk factors) and frequencies of stroke and etiology work-up. Chi-square and univariate analysis of variance “ANOVA” were used to investigate the relationship between risk factors and type of stroke. Finally, logistic regression analysis was used to measure the contribution of each of the independent variables. IRB approval was obtained as necessary. Results. The mean age for the cohort was 66.5 years. The most common risk factors were hypertension (78.8%), diabetes mellitus (60.5%), and ischemic heart disease (29.4%). The most common stroke etiology was small-vessel occlusion (54.2%). Median length of stay was 4 days. Prolonged length of stay was observed in 23.23% of patients, which was associated with several factors, the most common of which were persistent dysphagia (57.5%), nosocomial infection (39.3%), and combined dysphagia and nosocomial infection (21.2%). The mean admission NIHSS score was 7.94, and on discharge was 5.76. In-hospital mortality was 2.81%, while 50% of patients had a favorable outcome on discharge (mRS score between 0-2). The mean discharge mRS score for the cohort was 2.47 (SD±1.79). Large artery atherosclerosis was associated with the highest residual disability with a mean score of 3.67 (SD±1.88), while the stroke of undetermined etiology was associated with the lowest residual disability with a mean score of 1.60 (SD±1.78). Significant predictors of mRS score were smoking (t 3.24, P<0.001), age (t 1.98, P<0.049), and NIHSS score (t 9.979, P 0.000). Conclusion. Ischemic strokes have different etiologies that are associated with different levels of impact on the patient’s clinical status and prognosis. Large artery atherosclerosis was associated with the highest residual disability. Regarding predictors of prognosis, current smoking status, age above 50, gender, and NIHSS on admission appear to be the strongest predictors of prognosis. Finally, higher NIHSS score on admission resulted in a longer hospital stay.

Modelling Modifiable Risk Factors of Stroke in South Africa: Classical and Bayesian Logistic Regression Models

“…All the covariates interact and together with older age, increase the risk of developing a stroke. The results of this study are consistent with a Jordanian study which identified hypertension, diabetes and heart problems as the most common risk factors of ischemic stroke [21].…”

Prevalence, Clinical Profile and Outcome of Patients Presenting with Stroke

“…On analysing the outcome of stroke patients using mRS score, 41% of patients had good outcome whereas 59% of patients had bad outcome in our study. In a study done by Qawasmeh et al, frequency of good and bad outcomes was equal in distribution [27]. The outcome among patients recovering from stroke can be variable.…”

Prevalence, severity and predictors of post-stroke depression in a prospective cohort of Jordanian patients

“…Stroke symptoms were reported as motor, sensory, dysarthria, aphasia, and others. Stroke severity was assessed using NIHSS score, with stroke severity stratified as mild (NIHSS less than 6), moderate (NIHSS 6-15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and very severe (more than 25) [2,25]. Disability was assessed using the modified Rankin Score (mRS), and a favorable outcome was identified as having mRS score of 2 or less [2,25].…”

“…Stroke severity was assessed using NIHSS score, with stroke severity stratified as mild (NIHSS less than 6), moderate (NIHSS 6-15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and very severe (more than 25) [2,25]. Disability was assessed using the modified Rankin Score (mRS), and a favorable outcome was identified as having mRS score of 2 or less [2,25]. Functional status was assessed with Barthel Index (BI) [25], with the level of dependence classified as total (scores 0-20), severe , moderate (61-90), slight (91-99), and complete independence (100) [26].…”

“…Stroke is a significant cause of morbidity and mortality globally [1]. It is the second leading noncommunicable cause of death in Jordan and a considerable source of complications and physical disability [2,3]. Stroke survivors are liable to a multitude of physical, psychiatric, social, and functional impacts.…”