Abstract
BackgroundWe 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.MethodsBetween 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.ResultsWe 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.ConclusionMortality 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.
Highlights
The trend towards an increasing burden of noncommunicable chronic diseases (NCDs) including stroke in developing countries is of great concern [1]
We excluded participants who were: 1) unable to consent or for whom consent could not be obtained from a caregiver; (2) unable to communicate and without a caregiver respondent; (3) those who died within 24 h on the ward before neuroimaging was done; and 4) those who presented more than 7 days after onset of symptoms
Participants’ recruitment and outcome assessment profile During the study period, 153 stroke patients attending Nsambya hospital were screened for eligibility
Summary
The trend towards an increasing burden of noncommunicable chronic diseases (NCDs) including stroke in developing countries is of great concern [1]. The World Health Organization (WHO) estimates that by 2030, 80% of all stroke will occur in people living in low and middle income countries (LMICs), where it will account for 7.9% of all mortality [2, 3]. In sub-Saharan Africa (SSA), the burden of stroke is increasing as the population undergoes epidemiological and demographic change [4]. All-stroke mortality from the available Ugandan hospital-based studies, is estimated to be between 30 and 40% at 1 month [5, 6], which is much higher than the 20% mortality reported in the rest of the world [7]. 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
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