A Prospective Observational Study of Short-term Mortality Indicators in Acute Stroke Patients

Abstract

Introduction: Stroke is the second leading cause of death worldwide, causing 6.2 million deaths in 2011. There is a lack of uniform consensus regarding the predicting factors for mortality associated with stroke. Aim: To determine the various factors which influence the mortality in acute stroke. Materials and Methods: This was a prospective study conducted between November 2017 to February 2020 at the hospitals attached to Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. All the patients diagnosed with Cerebrovascular Accident (CVA) using neuroimaging of brain within 24 hours of a symptoms were enrolled and followed-up for 28 days. After obtaining informed consent, demographic, clinical, laboratory and radiological data was recorded. Patients were assessed using standardised data sheet containing different variables and treated appropriately for ischaemic and haemorrhagic stroke. Results: The study included 100 patients; 33 died during follow- up. The mean age of the patients was 55.35±15.78 years; there were 54 males and 46 females. Male gender (p-value <0.001), poor Glasgow Coma Scale (GCS) (p-value <0.001), severe neurodeficit (p-value <0.001), raised intracranial pressure (p-value <0.001) and complication like delayed recovery of GCS (p-value <0.001), aspiration pneumonia (p-value<0.001), Acute Kidney Injury (AKI) (p-value <0.001), fever (p-value <0.001), dysphagia (p-value <0.001), bedsore (p-value <0.001) and seizure (p-value <0.001) were the predictors of mortality in acute stroke. Conclusion: The factors like poor GCS, severe neurodeficit, raised intracranial pressure at the time presentation of patient and occurrence of complication like delayed recovery of GCS, aspiration pneumonia, AKI, fever, dysphagia, bedsore and seizure can be used as prognostic marker in acute stroke. Comprehensive neurological care wherever feasible involving neurologist, neurosurgeon, interventional radiologist, physiotherapist which take care of the immediate need and to prevent the long term complication would help to decrease mortality in acute stroke.