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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; 19:527-541. [PMID: 37649671 PMCID: PMC10464890 DOI: 10.2147/vhrm.s399815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
Background Stroke is the leading cause of cardiovascular disease death in sub-Saharan Africa and the second leading cause of mortality worldwide. In 2016, 6.23% of all fatalities in Ethiopia were stroke-related. Objective To assess survival status and predictors of mortality among adult stroke patients admitted to Jimma University Medical Center from April 1/2017 to March 31/2022. Methods A retrospective cohort study was conducted on 480 adult stroke patients selected by simple random sampling from patients admitted to the Jimma University Medical Center Stroke Unit from April 1, 2017 to March 31, 2022. Data were extracted from May to June 2022 and entered Epi-data v.3.1 and analyzed by R v.4.2. The Kaplan-Meier curve with Log rank test was used to estimate survival time and to compare survival experience between categories of explanatory variables. The Cox regression model was computed to identify predictors of survival status in stroke patients. Then the 95% CI of the hazard ratio was set with corresponding p-value < 0.05 to declare statistical significance. Results During 4350 person-days of follow-up; 88 (18.33%) patients died; resulting in an incidence mortality of 20.23 per 1000 person-days, with a median survival time of 38 days. Glasgow coma score <8 on admission (AHR = 7.71; 95% CI: 3.78, 15.69), dyslipidemia (AHR = 3.96; 95% CI: 2.04, 7.69), aspiration pneumonia (AHR 2.30; 95% CI: 1.23-4.26), and increased intracranial pressure (AHR = 4.27; 95% CI: 2.33, 7.81), were the independent predictors of the time until death. Conclusion The incidence of stroke mortality was higher at the seven and fourteen days. Glasgow Coma Scale, increased intracranial pressure, dyslipidemia, and aspiration pneumonia were independent predictors of mortality.
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Affiliation(s)
- Wakgari Mosisa
- Department of Public Health, Institute of Health Sciences, Dambi Dollo University, Dambi Dollo, Ethiopia
| | - Yenealem Gezehagn
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
| | - Guta Kune
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
| | - Melese Chego
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Hamba Fida Yigezu
- Department of Public Health, Institute of Health Sciences, Dambi Dollo University, Dambi Dollo, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
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Delgardo M, Rabin G, Tudor T, Tang AJ, Reeves G, Connolly ES. Monitoring risk and preventing ischemic stroke in the very old. Expert Rev Neurother 2023; 23:791-801. [PMID: 37540092 DOI: 10.1080/14737175.2023.2244674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Stroke is a significant cause of death, and the leading cause of severe long-term disability for individuals over 80 (the very old), yet few studies of such risk factors for ischemic stroke, or the known mitigation techniques, in this population, and the evidence base regarding risk modification strategies in this susceptible population can be inconsistent and incomplete. This article examines current guidelines and evidence regarding medical management, lifestyle changes, and psychosocial interactions that can contribute to the primary and secondary prevention of ischemic stroke in the very old. AREAS COVERED The authors conducted a literature search for ischemic stroke prevention and risk assessment in the elderly via PubMed. Furthermore, they describe current strategies for monitoring risk and preventing ischemic stroke in the elderly population. EXPERT OPINION Ischemic stroke poses a significant health risk to the elderly, with prevention relying on managing modifiable risk factors such as hypertension, atrial fibrillation, diabetes, and high cholesterol, as well as promoting healthy lifestyle choices like quitting smoking, regular physical activity and a heart-healthy diet. Healthcare providers must adopt a multifaceted approach, addressing individual and population-level factors while remaining vigilant in monitoring and managing risk factors to reduce the incidence and impact of stroke in older adults.
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Affiliation(s)
- Mychael Delgardo
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Grant Rabin
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Thilan Tudor
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Anthony J Tang
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Geoffrey Reeves
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - E Sander Connolly
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
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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; 16:389-401. [PMID: 33061400 PMCID: PMC7533221 DOI: 10.2147/vhrm.s247667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/15/2020] [Indexed: 01/14/2023] Open
Abstract
Background Globally, stroke appears as a major cause of preventable deaths and disabilities. In Ethiopia, the intra-hospital mortality of stroke is significant; however, epidemiologic data are scarce whether there is a difference in the overall survival time between hypertensive and non-hypertensive adult stroke patients admitted in specialized hospitals. This study was intended to determine the survival of stroke patients according to their hypertension status admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia from March 1, 2012, to February 28, 2019. Methods and Findings A hospital-based retrospective cohort study was conducted among all cohorts of confirmed first-ever stroke patients admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Kaplan–Meier survival analysis was applied to estimate the survival probability of hypertensive and non-hypertensive first-ever stroke patients. Cox proportional hazards regression model was used to determine the adjusted hazard ratio of death for each main baseline predictor variable with 95% CI, and P-value <0.05 was used to declare statistical significance. The assumptions of the Cox proportional hazards regression model assessed by the global test, Schoenfeld residuals. There were 503 (323 were hypertensive, 180 Non-hypertensive) confirmed first, ever adult stroke patients, the overall median age of the patients was 65 years, IQR (53–75) years. Seventy-five (14.9%) of them were dead, with a median survival time of 48 days and 428 (85.1%) of them were censored. At any particular point in time, the hazard of death among hypertensive patients was two times higher than non-hypertensive patients, but this was not found to be a statistically significant (adjusted HR=2.13: 95% CI 0.66–6.81). Glasgow Coma Scale 3–8 at admission (adjusted HR=10.12; 95% CI 2.58–40.68), presence of stroke complications (adjusted HR=7.23; 95% CI 1.86–28.26) and borderline high total cholesterol level (adjusted HR=3.57; 95% CI 1.15–11.1) were the only independent predictors of intra-hospital patient mortality. Conclusion The overall survival time difference between hypertensive and non-hypertensive first-ever adult stroke patients was not statistically significant. Early identification and treatment of stroke complications, co-morbidities along strict follow-up of comatose patients may improve the intra-hospital survival of stroke patients, and we also recommend community-based studies using a large sample size.
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Affiliation(s)
- Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Naod Firdu Gizaw
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondimu Ayele
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Mamushet Yifru
- Department of Neurology, Faculty of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nigus Alemu Hailu
- Department of Biomedical Sciences, School of Medicine, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Embaba Tekelaye Welesemayat
- Department of Epidemiology, School of Public Health, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Etsay Weldekidan Tsegay
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Abadi Hailay Atsbaha
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Hirut Teame Gebru
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
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Scalise M, Brechtel L, Conn Z, Bailes B, Gainey J, Nathaniel TI. Predicting ambulatory recovery in acute ischemic stroke patients with thrombolytic therapy. FUTURE NEUROLOGY 2020. [DOI: 10.2217/fnl-2020-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aim: The aim of this study was to determine the predictive value of clinical presentations on functional ambulation following thrombolytic therapy. Materials & methods: Logistic regression analysis was used to determine associations between functional ambulation and thrombolytic therapy. Results & conclusion: In the results, Hispanic ethnicity (odds ratio (OR): 2.808; p = 0.034; 95% CI: 1.08–7.30), high National Institute of Health Stroke Scale (NIHSS) (OR: 1.112; p ≤ 0.001; 95% CI: 1.06–1.17), weakness/paresis (OR: 1.796; p = 0.005; 95% CI: 1.19–2.71), Broca’s aphasia (OR: 1.571; p = 0.003; 95% CI = 1.16–2.12) and antihypertensive medication (OR: 1.530; p = 0.034; 95% CI: 1.03–2.26) were associated with an improved ambulation in patients without thrombolytic therapy. In thrombolytic treated patients, Broca’s aphasia was associated with improved functional outcome.
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Affiliation(s)
- Matthew Scalise
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605 USA
| | - Leanne Brechtel
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605 USA
| | - Zachary Conn
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605 USA
| | - Benjamin Bailes
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605 USA
| | - Jordan Gainey
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605 USA
| | - Thomas I Nathaniel
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605 USA
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Jiang L, Peng M, Chen H, Geng W, Zhao B, Yin X, Chen YC, Su H. Diffusion-weighted imaging (DWI) ischemic volume is related to FLAIR hyperintensity-DWI mismatch and functional outcome after endovascular therapy. Quant Imaging Med Surg 2020; 10:356-367. [PMID: 32190562 DOI: 10.21037/qims.2019.12.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND We assessed whether diffusion-weighted imaging (DWI) volume was associated with fluid-attenuated inversion recovery vascular hyperintensities (FVH)-DWI mismatch and functional outcome in patients with acute stroke who received endovascular therapy (EVT). METHODS Fifty-three acute stroke patients who received EVT were enrolled. FVH-DWI mismatch, DWI volume on admission, DWI volume on follow-up, DWI volume growth, the functional outcome at 3 months (mRS) and other clinical data were collected. Receiver operating characteristic (ROC) analysis was performed to evaluate the value of DWI volume in predicting functional outcome after stroke. RESULTS The FVH-DWI mismatch group had a smaller DWI volume on admission (13.86±19.58 vs. 65.07±52.21; t=-4.301, P=0.000), a smaller DWI volume on follow-up (29.88±33.52 vs. 112.43±87.19; t=-4.143, P=0.000), and a lower DWI volume growth (16.02±19.90 vs. 47.36±40.06; t=-3.326, P=0.003) than those of the no FVH-DWI mismatch group. The good functional outcome group had a smaller DWI volume on admission (13.30±13.26 vs. 68.56±54.28; t=-5.611, P=0.000), a smaller DWI volume on follow-up (27.65±18.80 vs. 120.25±90.37; t=-5.720, P=0.000), lower DWI volume growth (14.35±15.06 vs. 51.69±41.17; t=-4.737, P=0.001) and a higher FVH-DWI mismatch ratio (75.76% vs. 35%; t=8.647; P=0.004) than those of the poor functional outcome group. ROC analysis showed that the sensitivity and specificity of DWI volume on admission for predicting functional outcome were 65% and 96.97%, respectively (the optimal cut-off value: 33.50 mL); DWI volume on follow-up was 48.6 mL, with a sensitivity and specificity of 80% and 87.88%, respectively; DWI volume growth was 22.25 mL, with a sensitivity and specificity of 70% and 87.88%, respectively. CONCLUSIONS DWI volume and DWI volume growth can provide the prognostic information of acute stroke patients after thrombectomy.
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Affiliation(s)
- Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Mingyang Peng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Boxiang Zhao
- Department of Intervention, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Haobo Su
- Department of Intervention, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
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