Early mortality and functional outcome after acute stroke in Uganda: prospective study with 30聽day follow-up

详细信息    查看全文

• 作者：Jane Nakibuuka ; Martha Sajatovic ; Joaniter Nankabirwa ; Charles Ssendikadiwa…
• 关键词：Death ; Function ; Outcome ; Stroke
• 刊名：SpringerPlus
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：4
• 期：1
• 全文大小：833KB
• 参考文献：Adams HP, Bendixen BH, Kappelle LJ, Biller J, Gordon DL, Marsh EE (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35鈥?1CrossRef
  Adams HP, Haagsma J, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF (2007) Guidelines for the Early Management of Adults With Ischemic Stroke A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 115:e478鈥揺534CrossRef
  脕lvarez-Sab铆n J, Huertas R, Quintana M, Rubiera M, Delgado P, Rib贸 M, Molina CA, Montaner J (2007) Prior statin use may be associated with improved stroke outcome after tissue plasminogen activator. Stroke 38:1076鈥?078CrossRef
  Ayis SA, Coker B, Bhalla A, Wellwood I, Rudd AG, Di Carlo A, Bejot Y, Ryglewicz D, Rastenyte D, Langhorne P (2013) Variations in acute stroke care and the impact of organised care on survival from a European perspective: the European Registers of Stroke (EROS) investigators. J Neurol Neurosurg Psychiatry 84:604鈥?12CrossRef
  Bamford J, Sandercock P, Warlow C, Gray M (1986) Why are patients with acute stroke admitted to hospital? Br Med J (Clin Res Ed) 292:1369CrossRef
  Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Kriegler D, Mayberg M, Morgenstern L, Ogilvy CS, Vespa P (2007) Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults 2007 Update: A Guideline From the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 38:2001鈥?023CrossRef
  Carter KN, Anderson CS, Hackett ML, Barber PA, Bonita R (2006) Improved survival after stroke: is admission to hospital the major explanation? Trend analyses of the Auckland Regional Community Stroke Studies. Cerebrovasc Dis 23:162鈥?68CrossRef
  Collin C, Wade DT, Davies S, Horne V (1988) The Barthel ADL Index: a reliability study. Int Disabil Stud 10:61鈥?3CrossRef
  Connor MD, Walker R, Modi G, Warlow CP (2007a) Burden of stroke in black populations in sub-Saharan Africa. Lancet Neurol 6:269鈥?78CrossRef
  Connor MD, Thorogood M, Modi G, Warlow CP (2007b) The burden of stroke in Sub-Saharan Africa. Am J Prev Med 33:172鈥?73CrossRef
  Connor MD, Modi G, Warlow CP (2009) Differences in the nature of stroke in a multiethnic urban South African population: the Johannesburg hospital stroke register. Stroke 40:355鈥?62CrossRef
  Counsell C, Dennis M (2001) Systematic review of prognostic models in patients with acute stroke. Cerebrovas Dis 12:159鈥?70CrossRef
  Cztonkowska A, Ryglewicz D, Lechowicz W (1997) Basic analytical parameters as the predictive factors for 30-day case fatality rate in stroke. Acta Neurol Scand 95:121鈥?24CrossRef
  Dalal PM, Bhattacharjee M (2007) Stroke epidemic in India: hypertension-stroke control programme is urgently needed. J Assoc Physicians India 55:689鈥?91
  Dalal PM, Malik S, Bhattacharjee M, Trivedi ND, Vairale J, Bhat P, Deshmukh S, Khanelwal K, Mathur VD (2008) Population-based stroke survey in Mumbai, India: incidence and 28-day case fatality. Neuroepidemiology 31:254鈥?61CrossRef
  Daverat P, Castel JP, Dartigues JF, Orgogozo JM (1991) Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke 22:1鈥?CrossRef
  Feigin VL, Lawes CM, Bennett DA, Anderson CS (2003) Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2:43鈥?3CrossRef
  Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V (2009) Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 8:355鈥?69CrossRef
  Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, O鈥橠onnell M, Venketasubramanian N, Barker-Collo S, Lawes CM, Wang W, Shinohara Y, Witt E, Ezzati M, Naghayi M, Murray C (2014) Global and regional burden of stroke during 1990鈥?010: findings from the Global Burden of Disease Study 2010. Lancet 383:245鈥?54CrossRef
  Gray CS, Hildreth AJ, Alberti GKMM, O鈥機onnell JE (2004) Poststroke hyperglycemia natural history and immediate management. Stroke 35:122鈥?26CrossRef
  Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC (2008) Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis. Stroke 39:3029鈥?035CrossRef
  Heuschmann PU, Kolominsky-Rabas PL, Misselwitz B, Hermanek P, Leffmann C, Janzen RWC, Rother J, Buecker-Nott HJ, Berger K (2004) Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers Study Group. Arch Intern Med 164:1761鈥?768CrossRef
  Hier DB, Edelstein G (1991) Deriving clinical prediction rules from stroke outcome research. Stroke 22:1431鈥?436CrossRef
  Jongbloed L (1986) Prediction of function after stroke: a critical review. Stroke 17:765鈥?76CrossRef
  Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ (1996) Predicting disability in stroke鈥攁 critical review of the literature. Age Ageing 25:479鈥?89CrossRef
  Kwarisiima L, Mukisa R, Nakibuuka J, Matovu S, Katabira E (2014) Thirty-day stroke mortality and associated clinical and laboratory factors among adult stroke patients admitted at mulago hospital. Uganda AJNS 33:79鈥?6
  Langhorne P (2007) The main components of stroke unit care: what is the question? Cerebrovasc Dis 23:464CrossRef
  Mudzi W, Stewart A, Musenge E (2012) Case fatality of patients with stroke over a 12-month period post stroke. SAMJ S Afr Med J 102:765鈥?67
  O鈥橠onnell MJ, Xavier D, Liu L, Chin SL, Rao-Melacini P, Rangarajan S, Islam S, Pais P, McQueen MJ, Mondo C, Damasceno A, Lopez-Jaramillo P, Hankey GJ, Dans AL, Yusoff K, Truelsen T, Diener HC, Sacco RL, Ryglewicz D, Czlonkowska A, Weimar C, Wang X, Yusuf S (2010) Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 376:112鈥?23CrossRef
  Ogun SA (2004) Acute stroke mortality at Lagos University Teaching Hospital鈥攁 five year review. Nig Q J Hosp Med 10:8鈥?0
  Ogun S, Ojini FI, Ogungbo B, Kolapo KO, Danesi MA (2005) Stroke in south west Nigeria a 10-year review. Stroke 36:1120鈥?122CrossRef
  Ojini F, Ogun S, Danesi M (2008) Thirty-day case fatality of stroke at the Lagos University Teaching Hospital. Nig Q J Hosp Med 14:64鈥?6CrossRef
  Ovbiagele B, Buck BH, Liebeskind DS, Starkman S, Bang OY, Ali LK, Villablanca JP, Salamon N, Yun SW, Pineda S (2008) Prior antiplatelet use and infarct volume in ischemic stroke. J Neurol Sci 264:140鈥?44CrossRef
  Owolabi MO, Bower JH, Ogunniyi A (2007) Mapping Africa鈥檚 way into prominence in the field of neurology. Arch Neurol 64:1696鈥?700CrossRef
  Reed group (1991) Medical disability guidelines for definition of haemorrhagic stroke on computerised tomography scan. http://鈥媤ww.鈥媘dguidelines.鈥媍om/鈥媔ntracranialhemo鈥媟rhage/鈥媎efinitions . Accessed 21 Sept 2004
  Saposnik G, Hill MD, O鈥橠onnell M, Fang J, Hachinski V, Kapral MK (2008) Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke. Stroke 39:2318鈥?324CrossRef
  Scandinavian Stroke Study Group (1985) Multicenter trial of hemodilution in ischemic stroke-background and study protocol. Stroke 16:885鈥?90CrossRef
  Selim M, Savitz S, Linfante I, Caplan L, Schlaug G (2005) Effect of pre-stroke use of ACE inhibitors on ischemic stroke severity. BMC Neurol 5:10CrossRef
  Sheikh K, Brennan PJ, Meade TW, Smith DS, Goldenberg E (1983) Predictors of mortality and disability in stroke. J Epidemiol Community Health 37:70鈥?4CrossRef
  Smith EE, Shobha N, Dai D, Olson DM, Reeves MJ, Saver JL, Hernandez AF, Peterson ED, Fonarow GC, Schwann LH (2010) Risk score for in-hospital ischemic stroke mortality derived and validated within the Get With The Guidelines鈥揝troke Program. Circulation 122:1496鈥?504CrossRef
  Smith EE, Shobha N, Dai D, Olson DM, Reeves MJ, Saver JL, Hernandez AF, Peterson ED, Fonarow GC, Schwann LH (2013) A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke. J Am Heart Assoc 2:e005207CrossRef
  Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81鈥?4CrossRef
  The WHO MONICA Project Principal Investigators (1988) The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. J Clin Epidemiol 41:105鈥?14CrossRef
  Thijs V, Peeters A, Dewindt A, Hemelsoet D, De Klippel N, Laloux P, Redondo P, Cras P, De Deyn PP, Desfontaines P, Brouns R, De Raedt S, Van Landegem W, Vandermeeren Y, Vanhooren G (2009) Organisation of inhospital acute stroke care and minimum criteria for stroke care units. Recommendations of the Belgian Stroke Council. Acta Neurol Belg 109:247鈥?51
  Veerbeek JM, Kwakkel G, van Wegen EE, Ket JCF, Heymans MW (2011) Early Prediction of Outcome of Activities of Daily Living After Stroke A Systematic Review. Stroke 42:1482鈥?488CrossRef
  Wade DT, Hewer RL (1987) Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry 50:177鈥?82CrossRef
  Walker RW, Jusabani A, Aris E, Gray WK, Whiting D, Kabadi G, Mugusi F, Swai M, Alberti G, Unwin N (2011) Post-stroke case fatality within an incident population in rural Tanzania. J Neurol Neurosurg Psychiatry 82:1001鈥?005CrossRef
  Weimar C, Ziegler A, K枚nig IR, Diener HC (2002) Predicting functional outcome and survival after acute ischemic stroke. J Neurol 249:888鈥?95CrossRef
  Whiteley W, Chong WL, Sengupta A, Sandercock P (2009) Blood markers for the prognosis of ischemic stroke a systematic review. Stroke 40:e380鈥揺389CrossRef
  Wilterdink JL, Bendixen B, Adams HP, Woolson RF, Clarke WR, Hansen MD (2001) Effect of prior aspirin use on stroke severity in the trial of Org 10172 in acute stroke treatment (TOAST). Stroke 32:2836鈥?840CrossRef
  Yoon SS, Dambrosia J, Chalela J, Ezzeddine M, Warach S, Haymore J, Davis L, Baird AE (2004) Rising statin use and effect on ischemic stroke outcome. BMC Med 2:4CrossRef
  
• 作者单位：Jane Nakibuuka (1)
  Martha Sajatovic (2)
  Joaniter Nankabirwa (1)
  Charles Ssendikadiwa (3)
  Anthony J. Furlan (4)
  Elly Katabira (1)
  James Kayima (1)
  Nelson Kalema (3)
  Jayne Byakika-Tusiime (5)
  Edward Ddumba (6)
  
  1. Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7051, Kampala, Uganda
  2. Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
  3. Department of Medicine, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
  4. University Hospitals Case Medical Center, Neurological Institute Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
  5. Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
  6. Department of Medicine, St Raphael of St Francis Nsambya Hospital, Nkozi University, P.O. Box 7146, Kampala, Uganda
  
• 刊物类别：Science, general;
• 刊物主题：Science, general;
• 出版者：Springer International Publishing
• ISSN：2193-1801

文摘

Identification of early outcomes post stroke and their predictors is important in stroke management strategies. We prospectively analysed 30-day outcomes (mortality and functional ability) after stroke and their predictors among patients admitted within 7 days post event to a national referral hospital in Uganda. This was a prospective study of acute stroke patients consecutively enrolled between February and July 2014. Social demographics, clinical, laboratory, imaging characteristics, outcomes (all through 30 days), time of death were assessed using standardised questionnaires. Multiple regression was used to analyse the independent influence of factors on outcomes. Of 127 patients, 88 (69.3 %) had ischemic stroke and 39 (30.7 %) had hemorrhagic stroke. Eight (6.3 %) died within 7 days, 34 (26.8 %) died within 30 days, with 2/3 of deaths occurring in hospital. Two were lost to follow up. Of 91 survivors, 49 (53.9 %) had satisfactory outcome, 42 (46.1 %) had poor functional outcome. At multivariate analysis, independent predictors of mortality at 30 days were unconsciousness (GCS <9), severe stroke at admission and elevated fasting blood sugar. None of the patients with functional independence (Barthel index 鈮?0) at admission died within 30 days. Inverse independent predictors of satisfactory outcome at 30 days were older age, history of hypertension and severe stroke at admission. Acute stroke patients in Uganda still have high rates of early mortality and poor functional outcomes. Independent predictors of mortality and poor functional outcome were severe stroke at admission, unconsciousness, high fasting blood sugar, old age and history of hypertension. Keywords Death Function Outcome Stroke