Stroke mortality and its determinants in a resource-limited setting: A prospective cohort study in Yaounde, Cameroon
Stroke mortality and its determinants in a resource-limited setting: A prospective cohort study in Yaounde, Cameroon
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DOI：
10.1016/j.jns.2015.08.033
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发表时间：
2015-11-15
影响因子：
4.4
通讯作者：
Kengne, Andre Pascal
中科院分区：
文献类型：
--
作者：
Nkoke, Clovis;Lekoubou, Alain;Kengne, Andre Pascal
背景：大约四分之三的中风死亡发生在发展中国家，包括撒哈拉以南非洲国家。短期和长期中风死亡率的数据需要卫生服务和政策formulation.Methods：我们前瞻性地随访中风发作，254例患者从最大的参考医院在雅温得（喀麦隆）。采用加速失效时间回归分析研究死亡率和决定因素。结果：1个月、6个月和12个月的中风死亡率分别为23.2%（缺血性卒中：20.4%，出血性卒中：26.1%，未确定卒中：34.8，p = 0.219），31.5%（缺血性卒中：31.5%，出血性卒中：30.4%，未确定卒中：34.8%，p = 0.927）和32.7%（缺血性卒中：32.1%，出血性卒中：30.4%，未确定卒中：43.5%，p = 0.496）。发热、吞咽困难和入院时NIHSS评分可独立预测1个月、6个月和12个月时的死亡率。收缩压（BP）升高可预测1个月时的死亡率。舒张压升高是出血性卒中患者一个月内死亡率的预测因子。入院时血红蛋白水平低，只能预测长期mortality.Conclusion：在这个资源有限的环境中，卒中后死亡率很高，5例死亡中有1例发生在1个月内，在指数事件发生后6个月和12个月内死亡率高达30%。发烧、中风严重程度、血压升高和贫血增加了死亡风险。我们的研究结果增加了在资源有限的环境中中风后预后不良的证据。(C)2015 Elsevier B.V.版权所有。
Background: About three quarters of stroke deaths occur in developing countries including those in sub-Saharan African. Short and long-term stroke fatality data are needed for health service and policy formulation.Methods: We prospectively followed up from stroke onset, 254 patients recruited from the largest reference hospitals in Yaounde (Cameroon). Mortality and determinants were investigated using the accelerated failure time regression analysis.Results: Stroke mortality rates at one-, six- and 12 months were respectively 23.2% (Ischemic strokes: 20.4%, hemorrhagic strokes: 26.1%, and undetermined strokes: 34.8, p = 0.219),31.5% (ischemic strokes: 31.5%, hemorrhagic strokes: 30.4%, and undetermined strokes: 34.8%, p = 0.927), and 32.7% (ischemic strokes: 32.1%, hemorrhagic strokes: 30.4%, undetermined strokes: 43.5%, p = 0.496). Fever, swallowing difficulties, and admission NIHSS independently predicted mortality at one month, six and 12 months. Elevated systolic blood pressure (BP) predicted mortality at one month. Elevated diastolic blood pressure was a predictor of mortality at one month in participants with hemorrhagic stroke. Low hemoglobin level on admission only predicted long term mortality.Conclusion: In this resource-limited setting, post-stroke mortality was high with 1 out of 5 deaths occurring at one month and up to 30% deaths at six and twelve months after the index event. Fever, stroke severity, elevated BP and anemia increased the risk of death. Our findings add to the body of evidence for the poor outcome after stroke in resource limited environments. (C) 2015 Elsevier B.V. All rights reserved.