Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study

Abstract

Background Stroke data from Sierra Leone is limited, despite the increase in global burden of the disease. The aim of this study was to assess the risk factors, clinical outcomes and predictors of stroke mortality at a tertiary hospital in Freetown, Sierra Leone. Methods This retrospective cohort study was conducted on stroke patients admitted at the Connaught Teaching Hospital between 1st January to December 31, 2018. Clinical data related to stroke, with variables including patients’ demographics, stroke subtype, vascular risk factors, modified Rankin Scale (mRS), and outcomes were documented. In-hospital mortality, associated risk factors and predictors of stroke were determined. The study was approved by the Sierra Leone Ethics and Scientific Review Committee. It was registered under Research Registry https://www.researchregistry.com/browse-the-registry#home/ with the unique identifying number researchregistry6009. Result We studied 178 (95 male and 83 female) patients. The mean age was 59.8 ± 14.0 years, median was 58.1years (ranging: 29–88 years). The commonest risk factors were hypertension (84.3%), tobacco smoking (35.9%) and alcohol (31.4%). Ischemic stroke confirmed by CT scan was 76.3%. In-hospital mortality was 34.8% and at discharge, mean modified Rankin Score (mRS) was 3.89 ± 1.62. The independent predictors for stroke mortality were: hypertension [AOR = 2.2; C.I 95%: (1.32–3.80), p = 0.001], previous stroke [AOR = 2.31; C.I 95%: (1.43–5.74), p = 0.001], GCS < 8 [AOR = 6.06; C.I 95%: (3.17–12.79), p < 0.001], clinical diagnosis in the absence of imaging [AOR = 3.11; C.I 95%: (2.1–9.87), p = 0.001], hemorrhagic stroke [AOR = 2.96; C.I 95%: (1.96–9.54), p < 0.001], and aspiration pneumonia [(AOR = 3.03; C.I 95%:(1.44–6.36), p = 0.001]. Women had poorer outcome than men. Conclusion This study highlights a high stroke mortality in a resource limited hospital, with some stroke patients having difficulties in accessing Computer Tomogram (CT) scan services. It illustrates the need to establish a stroke care setting to improve the quality of stroke care.

In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: A systemic review and meta-analysis

“…The severity of stroke at admission, 21 , 25 ischemic types of stroke, 21 , 35 and undetermined types of stroke 16 were reported as determinants of in-hospital mortality among hospitalized stroke patients. A study by Garbusinski et al 21 revealed fever and lung infection were significant predictors of death.…”

“…11 , 21 , 24 , 34 The sample size of the included studies was ranged from 36 to 1054. 13 , 36 Of the total studies, most of them (15 studies) were conducted in Eastern Africa 15 , 16 , 19 , 20 , 22 – 24 , 26 – 29 , 31 , 32 , 34 , 37 and eight of them were in Western Africa 12 – 14 , 21 , 30 , 33 , 35 , 36 and the remaining four studies were conducted in Southern Africa 11 , 17 , 18 , 25 ( Table 2 ).…”

“… 14 Similarly, another study conducted in Western Africa depicted that the Glasgow Coma Scale <8 on admission was significantly associated with increased in-hospital mortality among stroke patients (adjusted odds ratio (AOR) = 6.06, 95% CI = 3.17–12.79). 35 …”

“… 23 However, another study has shown that the presence of hypertension at admission was significantly associated with all-cause mortality among stroke patients. 35 Previous stroke and clinical diagnosis were reported as a common risk factor of in-hospital mortality in a study conducted in Sierra Leone. 35 Moreover, female gender, 21 the severity of ictus at admission, 37 absence of aspirin treatment, 21 and a decrease in renal function 23 were also reported to influence the in-hospital mortality from acute stroke significantly.…”

“… 8 , 10 Several studies were conducted to evaluate the in-hospital mortality rate from acute stroke in sub-Saharan Africa. 11 – 37 However, the mortality rate has not been summarized to reflect the overall in-hospital mortality rate in the region. Hence, this systematic review and meta-analysis aimed to obtain more robust evidence on stroke treatment outcomes from the existing literature in sub-Saharan Africa countries.…”