Incidence and Predictors of In-hospital Mortality among First-ever Stroke Patients at Jimma University Medical Center, Ethiopia: A Retrospective Cohort Study

Abstract

Background: Stroke is a major cause of death and disability worldwide, with a disproportionate burden in low and lower-middle-income countries. Determining in-hospital mortality among first ever stroke indicates the quality of acute care provide and the ability to prevent immediate complications. According to the available evidence, research on in-hospital mortality among first ever stroke is limited in Ethiopia. Objective: This study aimed to determine time to in-hospital mortality, incidence rate, and predictors of in-hospital mortality among first-ever stroke patients admitted to the stroke units of Jimma University Medical Center (JUMC) between September 1, 2021, and September 1, 2023 Methods: This was a retrospective cohort study. A systematic sampling technique was used to select 210 first-ever stroke patients from three years of hospitalization records. Data were abstracted from medical records using a standardized data extraction form. All patients were followed up throughout their hospital stay. The outcome of the study was in-hospital mortality. Data analysis was conducted using Stata version 17. Continuous data were presented as means (±SD) or medians (IQR), and categorical data as frequencies and percentages. Kaplan–Meier survival analysis was used to describe survival to in-hospital mortality. The Cox proportional hazards model was used to identify predictors of time to in-hospital mortality. The results from the Cox models were presented as hazard ratios (HR) along with their 95% confidence intervals. Statistical significance was set at P < 0.05. Results: In this study, 210 stroke patients (ischemic stroke 51.9%) were included. The mean age of participants was 55.18 ± 14.83 years, and 63.3% were male. During 1,703 patient-days of follow-up, the incidence rate of in-hospital mortality was 1.76 per 100 patient-days, with a median time to death of 3 days (IQR: 2, 5). Independent predictors of in-hospital mortality were Glasgow Coma Scale scores at admission (aHR = 0.87, 95%CI: 0.78-0.96), and the occurrence of in-hospital complications (aHR = 6.58, 95%CI: 1.48-29.26). Conclusions and Recommendations: A lower GCS at admission and complications during hospital stay significantly increased the risk of in-hospital mortality. Thus, the prevention of acute stroke complications may improve the outcomes of patients with first-ever stroke.