In-hospital mortality and its associated factors among hospitalized stroke patients at public hospitals of Eastern Ethiopia.
Ethiopia
In-Hospital
Mortality
Stroke
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
28 Aug 2024
28 Aug 2024
Historique:
received:
28
02
2024
accepted:
08
08
2024
medline:
28
8
2024
pubmed:
28
8
2024
entrez:
27
8
2024
Statut:
epublish
Résumé
Stroke is rapidly developing clinical signs of focal/ global disturbance of cerebral function, with symptoms lasting more than 24 h and leading to death. Data showed that stroke deaths in Ethiopia reached nearly seven percent of total deaths. Despite this report, there is a paucity of investigations about the problem. To determine in-hospital mortality and its associated factors among hospitalized stroke patients in Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital, eastern Ethiopia from September 2016-August 2022 G.C. A retrospective cohort study was conducted among hospitalized stroke patients. A sample size of 395 medical records was selected from a total of 564 stroke patients by a simple random sampling technique. The data was analyzed by SPSS version 26 using bivariable and multivariable cox-regression models. A p-value of 0.05 and less at a 95% confidence interval was used to establish a statistically significant association. Of the total, 109 (27.6%) died in the hospital while 57.2% and 15.2% of them were discharged with improvement and against medical advice, respectively. Age greater than 65 (AHR = 4.71, 95% CI = 1.11-19.96), creatinine level > 1.2 mg/dl (AHR = 1.54, 95% CI = 1.0-2.39), and co-morbidity with atrial fibrillation (AHR = 1.48, 95% CI = 1.0-2.21) were significantly associated with in-hospital mortality. In-hospital mortality was found in more than a quarter of stroke patients. Mortality was more likely increased among the patients with age > 65, serum creatinine level > 1.2 mg/dl, and atrial fibrillation. Hence, these high-risk patients need to be monitored.
Sections du résumé
BACKGROUND
BACKGROUND
Stroke is rapidly developing clinical signs of focal/ global disturbance of cerebral function, with symptoms lasting more than 24 h and leading to death. Data showed that stroke deaths in Ethiopia reached nearly seven percent of total deaths. Despite this report, there is a paucity of investigations about the problem.
OBJECTIVE
OBJECTIVE
To determine in-hospital mortality and its associated factors among hospitalized stroke patients in Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital, eastern Ethiopia from September 2016-August 2022 G.C.
METHODS
METHODS
A retrospective cohort study was conducted among hospitalized stroke patients. A sample size of 395 medical records was selected from a total of 564 stroke patients by a simple random sampling technique. The data was analyzed by SPSS version 26 using bivariable and multivariable cox-regression models. A p-value of 0.05 and less at a 95% confidence interval was used to establish a statistically significant association.
RESULTS
RESULTS
Of the total, 109 (27.6%) died in the hospital while 57.2% and 15.2% of them were discharged with improvement and against medical advice, respectively. Age greater than 65 (AHR = 4.71, 95% CI = 1.11-19.96), creatinine level > 1.2 mg/dl (AHR = 1.54, 95% CI = 1.0-2.39), and co-morbidity with atrial fibrillation (AHR = 1.48, 95% CI = 1.0-2.21) were significantly associated with in-hospital mortality.
CONCLUSION
CONCLUSIONS
In-hospital mortality was found in more than a quarter of stroke patients. Mortality was more likely increased among the patients with age > 65, serum creatinine level > 1.2 mg/dl, and atrial fibrillation. Hence, these high-risk patients need to be monitored.
Identifiants
pubmed: 39192236
doi: 10.1186/s12872-024-04106-4
pii: 10.1186/s12872-024-04106-4
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
456Informations de copyright
© 2024. The Author(s).
Références
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–418.
doi: 10.1161/STR.0000000000000211
pubmed: 31662037
Daswani Bharti RM, Deepika N, Phate, Sagar D. Study of drug utilization and outcomes in stroke patient in a tertiary care hospital. 2021.
Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754–832.
Deljavan R, Farhoudi M, Sadeghi-Bazargani H. Stroke in-hospital survival and its predictors: the first results from Tabriz Stroke Registry of Iran. Int J Gen Med. 2018;11:233.
doi: 10.2147/IJGM.S158296
pubmed: 29950884
pmcid: 6016014
Uwishema O, Berjaoui C, Correia IFS, Anis H, Karabulut E, Essayli D, Mhanna M, Oluyemisi A. Current management of acute ischemic stroke in Africa: a review of the literature. Eur J Neurol. 2022.
Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, Abbasifard M, Abbasi-Kangevari M, Abd-Allah F, Abedi V. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the global burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795–820.
doi: 10.1016/S1474-4422(21)00252-0
Akinyemi RO, Ovbiagele B, Adeniji OA, Sarfo FS, Abd-Allah F, Adoukonou T, Ogah OS, Naidoo P, Damasceno A, Walker RW. Stroke in Africa: profile, progress, prospects and priorities. Nat Reviews Neurol. 2021;17(10):634–56.
doi: 10.1038/s41582-021-00542-4
Gadisa DA, Busawa GB, Gebremariam ET, Tefera GM, Belete KT, Taye GM, Meskele LB, Gudeta BM, Gelaw BK. Clinical characteristics, treatment outcomes, and its predictors among hospitalized stroke patients in Ambo University Referral Hospital, West Ethiopia: a Retrospective Hospital-based study. Vasc Health Risk Manag. 2020;16:591.
doi: 10.2147/VHRM.S287465
pubmed: 33447039
Walelgn N, Abyu GY, Seyoum Y, Habtegiorgis SD, Birhanu MY. The Survival Status and predictors of Mortality among Stroke patients at North West Ethiopia. Risk Manage Healthc Policy. 2021;14:2983–94.
doi: 10.2147/RMHP.S322001
Alene M, Assemie MA, Yismaw L, Ketema DB. Magnitude of risk factors and in-hospital mortality of stroke in Ethiopia: a systematic review and meta-analysis. BMC Neurol. 2020;20:1–10.
doi: 10.1186/s12883-020-01870-6
Hagos Gufue Z, Gizaw NF, Ayele W, Yifru YM, Hailu NA, Welesemayat ET, Tsegay EW, Atsbaha AH, Gebru HT. Survival of stroke patients according to hypertension status in Northern Ethiopia: seven years retrospective cohort study. Vasc Health Risk Manag. 2020:389–401.
Abera SF. Epidemiology and social determinants of chronic diseases attributed adult mortality and its influence on maternal and young child nutrition in Tigray, 2009–2015: evidence from Kilte Awlaelo-Health and Demographic Surveillance Site. Dissertation, Hohenheim, Universität Hohenheim. 2024.
Mosisa W, Gezehagn Y, Kune G, Chego M, Yigezu HF, Getnet M. Survival status and predictors of mortality among adult stroke patients admitted to Jimma University Medical Center, South West Ethiopia: a retrospective cohort study. Vasc Health Risk Manag. 2023;19:527–41.
doi: 10.2147/VHRM.S399815
pubmed: 37649671
pmcid: 10464890
Baye M, Hintze A, Gordon-Murer C, Mariscal T, Belay GJ, Gebremariam AA, Hughes CML. Stroke characteristics and outcomes of adult patients in Northwest Ethiopia. Front Neurol. 2020;11:428. https://doi.org/10.3389/fneur.2020.00428
Abdo R, Abboud H, Salameh P, El Hajj T, Hosseini H. Mortality and predictors of death poststroke: data from a Multicenter prospective cohort of Lebanese stroke patients. J Stroke Cerebrovasc Diseases: Official J Natl Stroke Association. 2019;28(4):859–68.
doi: 10.1016/j.jstrokecerebrovasdis.2018.11.033
Mohammed AS, Degu A, Woldekidan NA, Adem F, Edessa D. In-hospital mortality and its predictors among stroke patients in sub-saharan Africa: a systemic review and meta-analysis. SAGE open Med. 2021;9:20503121211036789.
doi: 10.1177/20503121211036789
pubmed: 34377477
pmcid: 8326621
JGH H. Annual report. In.: Hiwot Fana Comprehensive Specialized Hospital and Jugal General Hospital. 2020.
Beyene DT, Asefa H. A two year retrospective cross-sectional study on prevalence, associated factors and treatment outcome among patients admitted to medical ward (stroke unit) at Jimma University Medical Center, Jimma, South West, Ethiopia, 2018. Palliat Med Care. 2018;5(4):1–6.
Temesgen TG, Teshome B, Njogu P. Treatment outcomes and associated factors among hospitalized stroke patients at Shashemene Referral Hospital, Ethiopia. Stroke research and treatment. 2018;2018.
Zewudie AZ, Regasa T, Hambisa S, Nureye D, Mamo Y, Aferu T, Feyissa D, Yosef T. Treatment Outcome and Its Determinants among Patients Admitted to Stroke Unit of Jimma University Medical Center, Southwest Ethiopia. Stroke research and treatment. 2020;2020.
Abdella SG, Gebi NB, Gerffie ES, Tamirat KS. Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia. Research square. 2019.
Beyene N, Fanta K, Tatiparthi R. Pharmacotherapy Pattern and Treatment outcomes of Stroke patients admitted to Jimma University Medical Center, Ethiopia. Patient Relat Outcome Measures. 2021;12:267.
doi: 10.2147/PROM.S307291
Fekadu G, Adola B, Mosisa G, Shibiru T, Chelkeba L. Clinical characteristics and treatment outcomes among stroke patients hospitalized to Nekemte referral hospital, western Ethiopia. J Clin Neurosci. 2020;71:170–6.
doi: 10.1016/j.jocn.2019.08.075
pubmed: 31471079
Gebreyohannes EA, Bhagavathula AS, Abebe TB, Seid MA, Haile KT. In-hospital mortality among ischemic stroke patients in Gondar University Hospital: a retrospective cohort study. Stroke research and treatment. 2019.
Neshuku SN, Kirchner-Frankle J, Nangolo M, Moses M, Einbeck CO, Kumire P, Zatjirua V, Banda J. The Burden and In-Hospital Mortality of Stroke Admissions at a Tertiary Level Hospital in Namibia: A Retrospective Cohort Study. Stroke research and treatment. 2023.
Desalu OO, Wahab KW, Fawale B, Olarenwaju TO, Busari OA, Adekoya AO, Afolayan JO. A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria. Ann Afr Med. 2011;10(2).
Kaseke F, Stewart A, Gwanzura L, Hakim J, Chikwasha V. Clinical characteristics and outcomes of patients with stroke admitted to three tertiary hospitals in Zimbabwe: a retrospective one-year study. Malawi Med J. 2017;29(2):177–82.
doi: 10.4314/mmj.v29i2.19
pubmed: 28955429
pmcid: 5610292
Walker RW, Rolfe M, Kelly PJ, George MO, James OFW. Mortality and recovery after stroke in the Gambia. Stroke. 2003;34(7):1604–9.
doi: 10.1161/01.STR.0000077943.63718.67
pubmed: 12817107
Nutakki A, Saylor D, Chishimba L, Chomba M, Mataa M, Zimba S. PREDICTORS OF STROKE MORTALITY AT UNIVERSITY TEACHING HOSPITAL IN LUSAKA, ZAMBIA. J Stroke Cerebrovasc Dis. 2022;31(4):106359.
doi: 10.1016/j.jstrokecerebrovasdis.2022.106359
Agyemang C, Attah-Adjepong G, Owusu-Dabo E, Aikins ADG, Addo J, Edusei AK, Nkum BC, Ogedegbe G. Stroke in Ashanti region of Ghana. Ghana Med J. 2012;46(2):12–7.
pubmed: 23661812
pmcid: 3645146
Damasceno A, Gomes J, Azevedo A, Carrilho C, Lobo V, Lopes H, Madede T, Pravinrai P, Silva-Matos C, Jalla S. An epidemiological study of stroke hospitalizations in Maputo, Mozambique: a high burden of disease in a resource-poor country. Stroke. 2010;41(11):2463–9.
doi: 10.1161/STROKEAHA.110.594275
pubmed: 20930157
Gedefa B, Menna T, Berhe T, Abera H. Assessment of risk factors and treatment outcome of stroke admissions at St. Paul’s teaching hospital, addis ababa, Ethiopia. J Neurol Neurophysiol. 2017;8(3):1–6.
doi: 10.4172/2155-9562.1000431
Ekeh B, Ogunniyi A, Isamade E, Ekrikpo U. Stroke mortality and its predictors in a Nigerian teaching hospital. Afr Health Sci. 2015;15(1):74–81.
doi: 10.4314/ahs.v15i1.10
pubmed: 25834533
pmcid: 4370132
Russell JBW, Charles E, Conteh V, Lisk DR. Risk factors, clinical outcomes and predictors of stroke mortality in Sierra leoneans: a retrospective hospital cohort study. Annals Med Surg. 2020;60:293–300.
doi: 10.1016/j.amsu.2020.10.060
Nagurney JT, Brown DFM, Sane S, Weiner JB, Wang AC, Chang Y. The accuracy and completeness of data collected by prospective and retrospective methods. Acad Emerg Med. 2005;12(9):884–95.
doi: 10.1197/j.aem.2005.04.021
pubmed: 16141025
Kelly C, Hulme C, Farragher T, Clarke G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open. 2016;6(11):e013059.
doi: 10.1136/bmjopen-2016-013059
pubmed: 27884848
pmcid: 5178808
Dussault G, Franceschini MC. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health. 2006;4(1):12.
doi: 10.1186/1478-4491-4-12
pubmed: 16729892
pmcid: 1481612
Van Lerberghe W, Conceicaõ C, Van Damme W, Ferrinho P. When staff is underpaid: dealing with the individual coping strategies of health personnel. Bull World Health Organ. 2002;80:581–4.
pubmed: 12163923
pmcid: 2567566
Reistetter TA, Karmarkar AM, Graham JE, Eschbach K, Kuo Y-F, Granger CV, Freeman J, Ottenbacher KJ. Regional Variation in Stroke Rehabilitation outcomes. Arch Phys Med Rehabil. 2014;95(1):29–38.
doi: 10.1016/j.apmr.2013.07.018
pubmed: 23921200
Langagergaard V, Palnum KH, Mehnert F, Ingeman A, Krogh BR, Bartels P, Johnsen SP. Socioeconomic Differences in Quality of Care and Clinical Outcome after Stroke. Stroke. 2011;42(10):2896–902.
doi: 10.1161/STROKEAHA.110.611871
pubmed: 21817140
de Oliveira ADP, de Andrade-Valença LPA, Valença MM. Factors associated with in-hospital mortality in very elderly patients with ischemic stroke: a cohort study. J Stroke Cerebrovasc Dis. 2019;28(10):104281.
doi: 10.1016/j.jstrokecerebrovasdis.2019.06.039
pubmed: 31351827
Kaduka L, Muniu E, Oduor C, Mbui J, Gakunga R, Kwasa J, Wabwire S, Okerosi N, Korir A, Remick S. Stroke mortality in Kenya’s public tertiary hospitals: a prospective facility-based study. Cerebrovasc Dis Extra. 2018;8(2):70–9.
doi: 10.1159/000488205
pubmed: 29895000
pmcid: 6031945
Nicholson M, Chan N, Bhagirath V, Ginsberg J. Prevention of venous thromboembolism in 2020 and Beyond. J Clin Med. 2020;9(8).
Anderson FA Jr., Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):19–16.
pubmed: 12814980
Labodi LD, Kadri C, Valentin YN, Christian N, Jean KB. Intra-hospital mortality of stroke and its predictive factors in a reference hospital in Ouagadougou, Burkina Faso. Brain. 2017;1(3):1–6.
Seifu L, Gashaye Y, Taye M. Renal dysfunction among stroke patients, Hospital Based Cross Sectional Study, Addis Ababa, Ethiopia, 2021. Ethiop J Health Dev. 2023;37(1).
Khatri R, Afzal MR, Qureshi MA, Maud A, Huanyu D, Rodriguez GJ. Pre-existing renal failure increases in-hospital mortality in patients with intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2019;28(2):237–42.
doi: 10.1016/j.jstrokecerebrovasdis.2018.07.036
pubmed: 30448090
Moraes MA, Jesus PAPd, Muniz LS, Costa GA, Pereira LV, Nascimento LM, Teles CAS, Baccin CA, Mussi FC. Ischemic stroke mortality and time for hospital arrival: analysis of the first 90 days. Revista Da Escola De Enfermagem Da USP. 2023;57:e20220309.
pmcid: 10112237
Alberts M, Chen Y-W, Lin JH, Kogan E, Twyman K, Milentijevic D. Risks of stroke and mortality in Atrial Fibrillation patients treated with Rivaroxaban and Warfarin. Stroke. 2020;51(2):549–55.
doi: 10.1161/STROKEAHA.119.025554
pubmed: 31888412
pmcid: 7004448