Dmitriy Viderman1, Alpamys Issanov1, Talgat Temirov2,3, Ewan Goligher4,5,6, Philip la Fleur1. 1. Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan. 2. National Research Oncology Center, Nur-Sultan, Kazakhstan. 3. Astana Medical University, Nur-Sultan, Kazakhstan. 4. Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada. 5. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 6. Toronto General Hospital Research Institute, Toronto, ON, Canada.
Abstract
Background: Risk factors for medium to long-term mortality after stroke are well-established but predictors of in-hospital stroke mortality are less clearly characterized. Kazakhstan has the highest age-standardized mortality rate from ischemic stroke in the world. Methods: We performed a retrospective analysis of patients with stroke who were admitted over a 3.5-years period to the neurocritical care unit of a tertiary care hospital in Nur-Sultan, Kazakhstan. Results: In total, 148 critically ill patients were included in the analysis (84 ischemic stroke, 64 hemorrhagic stroke). The mean age was 63 years, 45% were male and the mean Glasgow Coma Score (±SD) at baseline was 10.3 (±3.4). The in-hospital mortality rate was similar in patients with ischemic (36%) and hemorrhagic (39%) stroke (HR 0.88, 95%CI 0.48-1.60). Median survival was 38 days (range: 1-89 days) in patients with ischemic stroke and 39 days (range: 1-63 days) in patients with hemorrhagic stroke. Univariable analysis found that patients who had a lower Glasgow Coma Scale, were in coma and who had cerebral edema were more likely to die in-hospital (P = 0.04, 0.02, <0.01, respectively). Conclusions: Our analysis showed that mortality risk in critically ill patients with hemorrhagic stroke was closer to mortality risk in patients with ischemic stroke than has been reported in other analyses. Hypertension, chronic heart failure, ischemic heart disease and atrial fibrillation were the most frequent comorbidities in patients who developed severe (life-threatening) stroke. Coma and cerebral edema on admission appear to be associated with poor outcome. This is the first publication of in-hospital stroke mortality from a Central Asian population and could form the basis for future research including development of risk scores and identifying modifiable risk factors.
Background: Risk factors for medium to long-term mortality after stroke are well-established but predictors of in-hospital strokemortality are less clearly characterized. Kazakhstan has the highest age-standardized mortality rate from ischemic stroke in the world. Methods: We performed a retrospective analysis of patients with stroke who were admitted over a 3.5-years period to the neurocritical care unit of a tertiary care hospital in Nur-Sultan, Kazakhstan. Results: In total, 148 critically illpatients were included in the analysis (84 ischemic stroke, 64 hemorrhagic stroke). The mean age was 63 years, 45% were male and the mean Glasgow Coma Score (±SD) at baseline was 10.3 (±3.4). The in-hospital mortality rate was similar in patients with ischemic (36%) and hemorrhagic (39%) stroke (HR 0.88, 95%CI 0.48-1.60). Median survival was 38 days (range: 1-89 days) in patients with ischemic stroke and 39 days (range: 1-63 days) in patients with hemorrhagic stroke. Univariable analysis found that patients who had a lower Glasgow Coma Scale, were in coma and who had cerebral edema were more likely to die in-hospital (P = 0.04, 0.02, <0.01, respectively). Conclusions: Our analysis showed that mortality risk in critically illpatients with hemorrhagic stroke was closer to mortality risk in patients with ischemic stroke than has been reported in other analyses. Hypertension, chronic heart failure, ischemic heart disease and atrial fibrillation were the most frequent comorbidities in patients who developed severe (life-threatening) stroke. Coma and cerebral edema on admission appear to be associated with poor outcome. This is the first publication of in-hospital strokemortality from a Central Asian population and could form the basis for future research including development of risk scores and identifying modifiable risk factors.
Authors: Charles R Wira; Emanuel Rivers; Cynthia Martinez-Capolino; Brian Silver; Gayathri Iyer; Robert Sherwin; Christopher Lewandowski Journal: West J Emerg Med Date: 2011-11
Authors: Amit R Nayak; Seema D Shekhawat; Neha H Lande; Anuja P Kawle; Dinesh P Kabra; Nitin H Chandak; Shweta R Badar; Dhananjay V Raje; Hatim F Daginawala; Lokendra R Singh; Rajpal S Kashyap Journal: Basic Clin Neurosci Date: 2016-10