Survival Status and Predictors of Mortality among Adult Stroke Patients Admitted To Jimma University Medical Center: Retrospective Cohort Study

Abstract

Background: Stroke is the second leading cause of mortality in the world and the first leading cardiovascular disease cause of death in sub-Saharan African countries, and stroke-related deaths accounted for 6.23% of total deaths in Ethiopia. However, there is limited scientific evidence on survival experience and its predictors among stroke patients in Ethiopia. Objective: To assess the Survival time of adult stroke patients and its predictors among adult stroke patients admitted at Jimma University Medical Center from April 1/2017 to March 31/2022. Method: A retrospective cohort study was conducted on 480 adult stroke patients selected by simple random sampling among patients admitted to the stroke unit of Jimma University Medical Center from April 1/2017 to March 31/2022. Data were extracted from May to June 2022, entered into Epidata version 3.1, and analyzed by the R 4.2 version. Kaplan Meier curve with Log-rank test was used to estimate survival time and compare survival experience among categories of explanatory variables. The Cox proportional hazard model’s assumptions were checked by Schoenfeld residual plot and global test. The Cox regression model was computed to identify predictors of the survival status of stroke patients. Then the 95% CI of hazard ratio with corresponding p-value < 0.05 was set to declare statistical significance. Result: The study involved 480 eligible stroke patients in total, with a mean age of 55.43 ± 14.56 years. During 4350 person-days follow-up; 88(18.33%) patients died; yielding incidence mortality of 20.23per 1000 person-days, with a median survival time of 38 days. The cumulative survival rates for the first 7, 14, and 30 days were 0.852, 0.795, and 0.608 respectively. Glasgow coma scale <8 at 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 time to death. Conclusion and Recommendation: The incidence of stroke mortality was higher in the seven and fourteen days, while the thirty-day mortality and median survival time were lower than in the previous studies. Glasgow Coma Scale, increased intracranial pressure, dyslipidemia, and aspiration pneumonia were independent predictors of mortality. Therefore, careful follow-up and early detection of stroke complications were recommended for unconscious patients.