Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study

Abstract

Background We report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients. Methods Between December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days. The modified Ranking Scale wasused to assess the level of disability and mortality after stroke. Stroke severity at admission was assessed using the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Examination included clinical neurological evaluation, laboratory tests and brain computed tomography (CT) scan. Kaplan-Meier curves and multivariate Cox proportional hazard model were used for unadjusted and adjusted analysis to predict mortality. Results We enrolled 141 patients; 48 (34%) were male, mean age was 63.2 (+ 15.4) years old; 90 (64%) had ischemic and 51 (36%) had hemorrhagic stroke; 81 (57%) were elderly (≥ 60 years) patients. Overall mortality was 44 (31%); 31 (23%) patients died within the first 30 days post-stroke and, an additional 13 (14%) died within 90 days post-stroke. Mortality for hemorrhagic stroke was 19 (37.3%) and 25 (27.8%) for ischemic stroke. After adjusting for age and sex, a GCS score below < 9 (adjusted hazard ratio [aHR] =3.49, 95% CI: 1.39–8.75) was a significant predictor of 30-day mortality. GCS score < 9 (aHR =4.34 (95% CI: 1.85–10.2), stroke severity (NIHSS ≥21) (aHR = 2.63, 95% CI: (1.68–10.5) and haemorrhagic stroke type (aHR = 2.30, 95% CI: 1.13–4.66) were significant predictors of 90-day mortality. Shorter hospital stay of 7–13 days (aHR = 0.31, 95% CI: 0.11–0.93) and being married (aHR = 0.22 (95% CI: 0.06–0.84) had protective effects for 30 and 90-day mortality respectively. Conclusion Mortality is high in the acute and sub-acute phase of stroke. Low levels of consciousness at admission, stroke severity, and hemorrhagic stroke were associated with increased higher mortality in this cohort of Ugandan stroke patients. Being married provided a protective effect for 90-day mortality. Given the high mortality during the acute phase, critically ill stroke patients would benefit from early interventions established as the post-stroke- standard of care in the country.

The effects of socioeconomic and geographic factors on chronic phase long-term survival after stroke in South Korea

“…Our results showed that intracranial hemorrhage, ischemic stroke, and unspecified subtypes had a higher risk of chronic phase mortality than subarachnoid hemorrhage. This finding is contrary to a previous study, which found that hemorrhagic stroke had a high mortality risk 26 , 31 , 32 . However, our finding may be because the number of patients in the subarachnoid hemorrhage group (the reference group) was small, and many patients with low subarachnoid hemorrhage severity were enrolled since the study was conducted on patients who survived at least two years after stroke onset.…”

Fecal Calprotectin Is Increased in Stroke

“…CRP is a marker of inflammation, and its elevation in acute stroke is reportedly a poor prognostic factor [ 17 ]. GCS is widely used in assessing level of consciousness, and low levels of GCS are reportedly associated with higher mortality [ 18 ]. Lymphocytes are a subset of leukocytes, and their depletion in acute stroke is associated with poor neurologic outcome [ 19 ].…”

Risk Factors for Long-Term Death After Medullary Infarction: A Multicenter Follow-Up Study

“…Stroke-related mortality varies considerably between stroke types, regions, and countries ( 25 ). However, the correlates of long-term poor prognosis and death are not well characterized in the context of medullary infarction.…”