Analysis of Mortality Risk in Stroke Patients for Optimizing Stroke Services

Lisda Amalia, Aditya Islami

Abstract


Introduction: The high mortality rate due to stroke causes a burden on health services, so it is essential to optimize stroke services. Mortality is one of the parameters used to assess stroke services. Hasan Sadikin General Hospital, as a stroke service support hospital, should carry out comprehensive service development, one of which is through continuous evaluation regarding the mortality rate of stroke patients being treated. This study aims to analyze the description of mortality in stroke patients at Hasan Sadikin General Bandung, Indonesia.
Subject and Methods: The study used a retrospective analytic method for stroke patients in the Neurology ward from January to April 2023. The patients were divided into two groups: those who died and those who returned home with improvement. Data were taken from medical records regarding age, onset, length of stay, NIHSS, initial leukocytes, NLR, and complications. The data were then analyzed using the Mann-Whitney correlation test.
Results: From this study showed that 22 patients died, and 70 patients were discharged with improvement. There were no statistically significant differences (p>0.05) in the variables of age, onset, and length of stay in the two groups. There were statistically significant differences (p<0.05) between the two groups on the NIHSS on admission, leukocyte count, NLR variables, and the presence or absence of complications.
Conclusion: NIHSS scores, leukocyte count, NLR, and complications significantly affect mortality in stroke patients. This can be the basis for preventing and managing complications to reduce mortality in stroke patients and achieve better-quality indicators of stroke services.

Keywords


Mortality, outcome, stroke

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References


Johnson CO, GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5): 439–458. Doi: 10.1016/S1474-4422(19)30034-1

Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke epidemiology in south, east, and south-east Asia: a review. J. Stroke. 2017;19(3):286–294. doi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647629/

Kemenkes RI. Hasil Riset Kesehatan Dasar Tahun 2018. Kementrian Kesehat. RI 53. 2018, 1689–99.

Alhazzani AA, Mahfouz AA, Abolyazid AY, Awadalla NJ, Katramiz K, Faraheen A, et al. In hospital stroke mortality: rates and determinants in Southwestern Saudi Arabia. Int J Environ Res Public Health. 2018;15(5):927. doi: 10.3390/ijerph15050927.

Viderman D, Issanov A, Temirov T, Goligher E, la Fleur P. Outcome predictors of stroke mortality in the neurocritical care unit. Front Neurol. 2020;11:579733. Doi: 10.3389/fneur.2020.579733.

Mohammed AS, Degu A, Woldekidan NA, Adem F, Edessa D. In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: a systemic review and meta-analysis. SAGE Open Med. 2021;9:2-11. Doi: 10.1177/20503121211036789.

Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C, et al. Thrombolysis is guided by perfusion imaging up to 9 hours after the stroke's onset. N Engl J Med. 2019;380(19):1795–1803. Doi: 10.1056/NEJMoa1813046.

Moraes MA, Jesus PAP, Muniz LS, Costa GA, Pereira LV, Nascimento LM, Teles CAS, Baccin CA, Mussi FC. Ischemic stroke mortality and time for hospital arrival: analysis of the first 90 days. Rev Esc Enferm USP. 2023;57:e20220309. doi: 10.1590/1980-220X-REEUSP-2022-0309en.

Kortazar-Zubizarreta I, Pinedo-Brochado A, Azkune-Calle I, Aguirre-Larracoechea U, Gomez-Beldarrain M, Garcia-Monco JC. Predictors of in-hospital mortality after ischemic stroke: A prospective, single-center study. Health Sci Rep. 2019;2(4):1-9. Doi: 10.1002/hsr2.110.

Dutta D, Cannon A, Bowen E. Validation and comparison of two stroke prognostic models for 30-day and 90-day mortality in hospitals. Eur Stroke J. 2017; 2(4): 327-34. Doi: 10.1177/2396987317703581

Tarvonen-Schröder S, Niemi T, Koivisto M. Inpatient Rehabilitation after acute severe stroke: predictive value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination. Adv Rehabil Sci Pract. 2023;12:1-11. Doi:10.1177/27536351231157966

Mittal SH, Goel D. Mortality in ischemic stroke score: A predictive score of mortality for acute ischemic stroke. Brain Circ. 2017;3(1):29-34. Doi: 10.4103/2394-8108.203256.

Sharath M, Siddegowda RB, Lonimath A, Cheluvaiah JD. An elevated neutrophil-to-lymphocyte ratio predicts in-hospital mortality in stroke patients: a prospective cohort study. Cureus. 2022;14(11):e31372. Doi: 10.7759/cureus.31372.

Amalia, L. Neutrophils-to-lymphocyte ratio associates with clinical outcome in acute ischemic stroke. Int J Neurology, 2022:23, 1–5. Doi: 10.5580/IJN.56300

Song SY, Zhao XX, Rajah G, Hua C, Kang RJ, Han YP, et al. Clinical significance of baseline neutrophil-to-lymphocyte ratio in patients with ischemic stroke or hemorrhagic stroke: an updated meta-analysis. Front Neurol. 2019;10:1032. Doi: 10.3389/fneur.2019.01032

Vural G, Gümüşyayla S, Akdeniz G. The Neutrophil/lymphocyte ratio in stroke patients and its relation with functional recovery. Medeniyet Med J. 2018;33:320–325. Doi: 10.5222/MMJ.2018.83097

Semerano A, Strambo D, Martino G, Comi G, Filippi M, Roveri L, Bacigaluppi M. Leukocyte counts and ratios are Predictive of stroke outcome and hemorrhagic complications independently of infections. Front Neurol. 2020;11(201): 1-7. Doi: 10.3389/fneur.2020.00201.

Quan K, Wang A, Zhang X, Wang Y. Leukocyte count and adverse clinical outcomes in acute ischemic stroke patients. Front Neurol. 2019;10(1240):1-13. Doi: 10.3389/fneur.2019.01240

Donkor ES. Stroke in the 21st Century: a snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat. 2018;27:1-10. doi: 10.1155/2018/3238165.

Bustamante A, Giralt D, García-Berrocoso T, Rubiera M, Álvarez-Sabín J, Molina C, Serena J, Montaner J. The impact of post-stroke complications on in-hospital mortality depends on stroke severity. Eur Stroke J. 2017;2(1):54-63. Doi: 10.1177/2396987316681872.




DOI: https://doi.org/10.24244/jni.v13i3.569

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