Impact of Baseline Characteristics on Stroke Outcomes in Pakistan: A Longitudinal Study Using the Modified Rankin Scale

Abstract

Introduction. Stroke is a leading cause of disability and mortality globally, with a significant impact on healthcare systems. Various factors, including age, gender, comorbidities, and the type of stroke, influence the burden of stroke and its outcomes. The study was conducted with an objective to determine the impact of baseline characteristics on the long-term functional outcome of stroke patients. Methods. This prospective observational study was conducted between April 6, 2022 - December 31, 2023, at a tertiary hospital. The study included patients with radiologically confirmed stroke, selected through convenience sampling. Stroke patients of any gender and all age groups, with any comorbidity, were included. The Modified Rankin Scale (mRS) assessed disability on admission and three months post-stroke. Results. Of the 213 patients, 122 (57.3%) were males and the majority, 199 (93.4%) individuals, had acute ischemic stroke. The median age of the participants was 60 years (range: 13-97 years; IQR=18 years). The mRS score on admission was poor (5.0; IQR=1.0) for patients ≥ 60 years. In 74 (34.74%) participants, the left middle cerebral artery was a frequently involved site. Age of ≥ 60 years (mRS=4.0; IQR=4.0; p=0.001) and the presence of ≥ 3 comorbidities (mRS=5.0; IQR=1.0; p=0.001) were significantly associated with poor outcomes three months post-stroke. Ordinal logistic regression revealed that a mRS score of 4 (OR=14.20; 95% CI=1.70-145.25; p=0.02) and a mRS score of 5 (OR=78.84; 95% CI=9.35-820.25; p < 0.001) on admission were associated with poor outcomes. In addition, the presence of ≥ 3 comorbidities (OR=4.59; 95% CI=14.65; p < 0.01) and increasing age (OR=1.04; 95% CI=1.01-1.07; p=0.02) were predictors of poor outcomes three months post-stroke. Conclusions. The study underscores the importance of early intervention and effective management of comorbidities to improve functional outcomes in stroke patients. It highlights the need for targeted stroke care and rehabilitation strategies.