Factors associated with death and predictors of one.month mortality from stroke in Kano, Northwestern Nigeria

Owolabi Lukman Femi; Nagoda Mansur

doi:10.4103/0976-3147.116460

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Original Article

4 (

Supp 1

); S56-S61

doi:

10.4103/0976-3147.116460

Factors associated with death and predictors of one.month mortality from stroke in Kano, Northwestern Nigeria

Owolabi Lukman Femi, Nagoda Mansur¹

Department of Medicine, Neurology Unit, Aminu Kano Teaching Hospital, Bayero University Kano,Nigeria

1Department of Murtala Muhammad Specialist Hospital Kano, Nigeria

Address for correspondence: Dr. Owolabi Lukman Femi Department of Medicine, Aminu Kano Teaching Hospital Kano, Nigeria. PMB 3452 Kano Nigeria drlukmanowolabi@yahoo.com

Journal of Neurosciences in Rural Practice

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Abstract

ABSTRACT

Background: In resource-poor setting, identification of predictors of death is of paramount importance for clinicians, so that specific therapies and management strategies can be applied to patients at high risk of dying. This study aims to determine the factors associated with death and predictors of in-patient mortality for stroke among a cohort of stroke patients in two tertiary centers in Northwestern Nigeria. Materials and Methods: This was a prospective study of consecutive patients with acute stroke who were admitted to tertiary hospitals in northwestern Nigeria. A single observer, using pre-defined diagnostic criteria, recorded the information of interest including length of stay, outcome (dead or alive all through 30 days), time of death. Result: A total of 273 patients comprising 179 male and 94 female stroke patients were recruited. One hundred and seventy-four (63.7%) had infarctive stroke while 99 (36.3%) had hemorrhagic stroke (91 intracerebral and 8 sub-arachnoid hemorrhage). One-month mortality was 37%, and the majority was patients with hemorrhagic stroke (69.6%). About two-third (74.5%) of the mortalities occurred during the first week of the event. Logistic regression showed that severe systolic blood pressure, severe diastolic pressure, second or more episode of stroke, severe GCS, seizures, abnormal pupillary size, hemorrhagic stroke type, presence of aspiration pneumonitis, RBS > 200 mg/dl were independent predictors of mortality in stroke. Conclusion: The present study provides information on factors associated with death in stroke. GCS < 8, seizures, abnormal pupillary size, hemorrhagic stroke, aspiration pneumonitis were independent predictors of mortality.

Keywords

Mortality

Northwestern Nigeria

predictors

stroke

Show Related Articles from PubMed

Conflict of Interest

None declared

References

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[Google Scholar]
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Osuntokun B. O., Bademosi O, Akinkugbe O. O., Oyediran A. B., Carlisle R, . Incidence of stroke in an African City: Results from the Stroke Registry Ibadan, Nigeria, 1973-1975. Stroke.. 1979;10:205-7.
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Ojini F. I., Danesi M. A., . Pattern of neurological admissions at the Lagos University Teaching Hospital. Nig J Clin Pract. 2003;5:38-41.
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Talabi O. A., . A 3-year review of neurologic admissions in University College Hospital Ibadan, Nigeria. West Afr J Med. 2003;22:150-1.
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Ogun S. A., Adelowo O. O., Familoni O. B., Jaiyesimi A. E., Fakoya E. A., . Pattern of medical admission at Ogun State University Teaching Hospital: A three year review. West Afr J Med. 2000;19:304-7.
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Owolabi L. F., Sheu M. N., Sheu M. Y., Fadare J, . Pattern of Neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria. Ann Indian Acad Neurol. 2010;13:167-70.
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Owolabi L. F., Nagoda M, . Stroke in developing countries: Experience at Kano, Northwestern Nigeria. Sudan JMS. 2012;7:9-14.
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Owolabi L. F., Ibrahim A, . Stroke in Young Adults: A prospective study from Northwestern Nigeria. ISRN Neurology. 2012;10:1-5.
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Owolabi L. F., Yakasai M. M., . Stroke-related Wernicke’s Aphasia Mistaken for Psychosis: A Case Report. J Med Trop. 2011;14(1):83-5.
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World Health Organization , . Recommendations on stroke prevention, diagnosis, and therapy. Stroke. 1989;20:1407-31.
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Ogun S. A., Odusote K. A., . Effectiveness of high dose dexamethazone in the treatment in the treatment of acute stroke. West Afr J Med. 2001;9:1-6.
[Google Scholar]
Ogungbo B. I., Gregsson B, Mendelow A. D., Walker R, . Cerebrovascular diseases in Nigeria: What do we know and what do we need to know? Trop Doc. 2003;33:25-30.
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Adams H. P. Jr, del Zoppo G, Alberts M. J., Bhatt D. L., Brass L, Furlan A, et al . Guidelines for the early management of adults with ischemic stroke. Stroke. 2007;38:1655-711.
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Viriyavejakul A, . Stroke in Asia: An epidemiological consideration. Clin Neuropharmacol. 1990;13:S26-33.
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Bwala S. A., . "Stroke in a sub-Saharan Nigerian hospital: A retrospective study. Trop Doct. 1989;19:11-4.
[Google Scholar]
Massaro A. R., . "Stroke in Brazil: A South America perspective," Int J Stroke. 2006;1:113-5.
[Google Scholar]
Nicoletti A, Sofia V, Giuffrida S, Bartoloni A, Bartalesi F, Bartolo M. L., et al . Prevalence of stroke: A door-to-door survey in rural Bolivia. Stroke. 2000;31:882-5.
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Sacco R. L., Boden-Albala B, Gan R, Chen X, Kargman D. E., Shea S, et al . Stroke incidence among white, black, and Hispanic residents of an urban community: The Northern Manhattan Stroke Study. Am J Epidemiol. 1998;147:259-68.
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Warlow C. P., . Epidemiology of stroke. Lancet. 1998;352:1-4.
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Ghandehari K, Pourzahed A, Taheri M, Abbasi M, Gorjestani S, Ahmadi A. M., et al . Estimation of Iranian stroke patients eligible for intravenous thrombolysis with tPA. Int J Stroke. 2009;4:236.
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Ghandehari K, Izadi Mood Z, . Cardioembolic strokes in Eastern Iran and the importance of rheumatic valvular disease. Turkish J Med Sci. 2006;36:3614.
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Komolafe M. A., Ogunlade O, Komolafe E. O., . Stroke mortality in a teaching hospital in South Western Nigeria. Trop Doct. 2007;37:186-8.
[Google Scholar]
Kumral E, Ozkaya B, Sagduyu A, Sirin H, Vardarli E, Pehlivan M, . The Ege Stroke Registry: Hospital-based study in Aegean region, Izmir, Turkey. Cerebrovasc Dis. 1998;8:278-88.
[Google Scholar]
Bornstein N. M., Aronovich B. D., Karepov V. G., Gur A. Y., Treves T. A., Oved M, et al . The Tel-Aviv Stroke Registry: The consecutive 3600 patients. Stroke. 1996;27:1770-3.
[Google Scholar]
Moulin T, Tatu L, Crépin-Leblond T, Chavot D, Bergès S, Rumbach T, . Besancom Stroke Registry: An acute stroke registry of 2,500 consecutive patients. Eur Neuro. 1997;38:10-20.
[Google Scholar]
Bak S, Bak L, Sorense J. S., . Prevalence of risk factors in cerebral ischemia. Ugeskr Laeger. 1995;157:444-6.
[Google Scholar]
Nwosu C. M., Nwabueze A. C., Ikeh V. O., . Stroke at the prime of life: A study of Nigerian Africans between the ages of 16 and 45 years. East Afr Med J. 1992;69:384-90.
[Google Scholar]
Onwuchewa A, Bellgam H, Asekomeh G, . Stroke at the university of port harcourt teaching hospital, rivers state, Nigeria. Trop Doct. 2009;39:150-2.
[Google Scholar]
Ong T. Z., Raymond A. A., . Risk factors for stroke and predictors of one-month mortality. Singapore Med J. 2002;43:517-21.
[Google Scholar]
Kumral E, Ozkaya B, Sagduyu A, Sirin H, Vardarli E, Pehlivan M, . et al. Cerebrovasc Dis. 1998;8:278-88.
[Google Scholar]
Anderson C. S., Jamrozik K. D., Broadhurst R. J., Stewart-Wynne E. G., . Predicting survival for 1 year among different subtypes of stroke. Stroke. 1994;25:1935-44.
[Google Scholar]
Bamford J, Dennis M. S., Sandercock P, Burn J, Warlow C, . The frequency, cause and timing of death within 30 days of a first ever stroke: The Oxfordshire Community Stroke Project. J Neurol Neurosurg Psychiatr. 1990;53:824-9.
[Google Scholar]
Stegmayr B, Vinogradova T, Malyutina S, Peltonen M, Nikitin Y, Asplund K, . Widening gap of stroke between East and West. Stroke. 2000;31:2-8.
[Google Scholar]
Jover-Saenz A, Porcel-Perez J. M., Vives-Soto M, Rubio-Caballero M, . Epidemiology of acute cerebrovascular disease in Lleida from 1996-1997. Rev Neurol. 1999;28:941-8.
[Google Scholar]
Mbala-Mukendi M, Tambwe M. J., Dikassa L. N., MBuyamba-Kabangu J. R., . Initial arterial pressure and prognosis of cerebrovascular accidents. Arch Mal Coeur Vaiss. 1995;88:21-5.
[Google Scholar]
Simon W. R., Francis A LM, Robert B. T., . The Relation of Blood Pressure to Stroke Prognosis. Ann Intern Med. 1978;89:15-20.
[Google Scholar]
Mazza A, Pessina A. C., Gianluca P, Tikhonoff V, Pavei A, . Casiglia E Pulse pressure: An independent predictor of coronary and stroke mortality in elderly females from the general population. Blood Press. 2001;10:205-11.
[Google Scholar]
Yang W, Lynette L. Y., Christopher L, Richard F. H., Janet F, . Influence of Hyperglycemia on Stroke Mortality. J Stroke Cerebrovasc Dis. 2001;10:11-8.
[Google Scholar]
Moulin T, Tatu L, Crépin-Leblond T, Chavot D, Bergès S, Rumbach T, . Besancom Stroke Registry: An acute stroke registry of 2,500 consecutive patients. Eur Neuro. 1997;38:10-20.
[Google Scholar]
Thorsten S, Gabriel M, Michael De G, Peter S, Rolf H, Werner H, . Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke. 1997;28:711-5.
[Google Scholar]
Burtin P, Bollaert P. E., Feldmann L, Lelarge P, Bauer P, Larcan A, . Prognosis of patients with stroke undergoing mechanical ventilation. Intensive Care Med. 1994;20:32-6.
[Google Scholar]
Chambers B. R., Norris J. W., Shurvell B. L., Hachinski V. C., . Prognosis of acute stroke. Neurology. 1987;37:221-5.
[Google Scholar]
Bonita R, Ford M. A., Stewart A. W., . Predicting survival after stroke: A three-year follow-up. Stroke. 1988;19:669-73.
[Google Scholar]
Sheikh K, Brennan P. J., Meade T. W., Smith D. S., Goldenberg E, . Predictors of mortality and disability in stroke. J Epidemiol Community Health. 1983;37:70-4.
[Google Scholar]
Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R, . "Malignant› middle cerebral artery territory infarction: Clinical course and prognostic signs. Arch Neurol. 1996;53:309-15.
[Google Scholar]
Smithard D. G., O’Neill P. A., Park C, Morris J, . Complications and outcome after acute stroke - does dysphagia matter? Complications and outcome after acute stroke - does dysphagia matter? Stroke. 1996;27:1200-4.
[Google Scholar]
Gordon C, Hewer R. L., Wade D. T., . Dysphagia in acute stroke. BMJ. 1987;295:411-4.
[Google Scholar]
Barer D. H., . The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry. 1989;52:236-41.
[Google Scholar]
Mann G, Hankey G. J., Cameron D, . Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744-8.
[Google Scholar]
Katzan I. L., Cebul R. D., Husak S. H., Dawson N. V., Baker D. W., . The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology. 2003;60:620-5.
[Google Scholar]
Davenport R. J., Dennis M. S., Wellwood I, Warlow C. P., . Complication after acute stroke. Stroke. 1996;27:415-20.
[Google Scholar]

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[1] Murray C. J., Lopez A. D., . Mortality by cause for eight regions of the world: Global burden of disease study. Lancet. 1997;349:1269-76.
[Google Scholar]

[2] Ogun S. A., Ojini F. I., Ogungbo B, Kolapo K. O., Danesi M. A., . Stroke in south west Nigeria: A 10-year review. Stroke. 2005;36:1120-2.
[Google Scholar]

[3] Osuntokun B. O., Bademosi O, Akinkugbe O. O., Oyediran A. B., Carlisle R, . Incidence of stroke in an African City: Results from the Stroke Registry Ibadan, Nigeria, 1973-1975. Stroke.. 1979;10:205-7.
[Google Scholar]

[4] Ogun S. A., . Acute stroke Mortality at Lagos University Teaching Hospital: A five year review. Nig Q J Hosp Med. 2000;10:8-10.
[Google Scholar]

[5] Ojini F. I., Danesi M. A., . Pattern of neurological admissions at the Lagos University Teaching Hospital. Nig J Clin Pract. 2003;5:38-41.
[Google Scholar]

[6] Talabi O. A., . A 3-year review of neurologic admissions in University College Hospital Ibadan, Nigeria. West Afr J Med. 2003;22:150-1.
[Google Scholar]

[7] Ogun S. A., Adelowo O. O., Familoni O. B., Jaiyesimi A. E., Fakoya E. A., . Pattern of medical admission at Ogun State University Teaching Hospital: A three year review. West Afr J Med. 2000;19:304-7.
[Google Scholar]

[8] Owolabi L. F., Sheu M. N., Sheu M. Y., Fadare J, . Pattern of Neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria. Ann Indian Acad Neurol. 2010;13:167-70.
[Google Scholar]

[9] Owolabi L. F., Nagoda M, . Stroke in developing countries: Experience at Kano, Northwestern Nigeria. Sudan JMS. 2012;7:9-14.
[Google Scholar]

[10] Owolabi L. F., Ibrahim A, . Stroke in Young Adults: A prospective study from Northwestern Nigeria. ISRN Neurology. 2012;10:1-5.
[Google Scholar]

[11] Owolabi L. F., Yakasai M. M., . Stroke-related Wernicke’s Aphasia Mistaken for Psychosis: A Case Report. J Med Trop. 2011;14(1):83-5.
[Google Scholar]

[12] World Health Organization , . Recommendations on stroke prevention, diagnosis, and therapy. Stroke. 1989;20:1407-31.
[Google Scholar]

[13] Ogun S. A., Odusote K. A., . Effectiveness of high dose dexamethazone in the treatment in the treatment of acute stroke. West Afr J Med. 2001;9:1-6.
[Google Scholar]

[14] Ogungbo B. I., Gregsson B, Mendelow A. D., Walker R, . Cerebrovascular diseases in Nigeria: What do we know and what do we need to know? Trop Doc. 2003;33:25-30.
[Google Scholar]

[15] Adams H. P. Jr, del Zoppo G, Alberts M. J., Bhatt D. L., Brass L, Furlan A, et al . Guidelines for the early management of adults with ischemic stroke. Stroke. 2007;38:1655-711.
[Google Scholar]

[16] Viriyavejakul A, . Stroke in Asia: An epidemiological consideration. Clin Neuropharmacol. 1990;13:S26-33.
[Google Scholar]

[17] Bwala S. A., . "Stroke in a sub-Saharan Nigerian hospital: A retrospective study. Trop Doct. 1989;19:11-4.
[Google Scholar]

[18] Massaro A. R., . "Stroke in Brazil: A South America perspective," Int J Stroke. 2006;1:113-5.
[Google Scholar]

[19] Nicoletti A, Sofia V, Giuffrida S, Bartoloni A, Bartalesi F, Bartolo M. L., et al . Prevalence of stroke: A door-to-door survey in rural Bolivia. Stroke. 2000;31:882-5.
[Google Scholar]

[20] Sacco R. L., Boden-Albala B, Gan R, Chen X, Kargman D. E., Shea S, et al . Stroke incidence among white, black, and Hispanic residents of an urban community: The Northern Manhattan Stroke Study. Am J Epidemiol. 1998;147:259-68.
[Google Scholar]

[21] Warlow C. P., . Epidemiology of stroke. Lancet. 1998;352:1-4.
[Google Scholar]

[22] Ghandehari K, Pourzahed A, Taheri M, Abbasi M, Gorjestani S, Ahmadi A. M., et al . Estimation of Iranian stroke patients eligible for intravenous thrombolysis with tPA. Int J Stroke. 2009;4:236.
[Google Scholar]

[23] Ghandehari K, Izadi Mood Z, . Cardioembolic strokes in Eastern Iran and the importance of rheumatic valvular disease. Turkish J Med Sci. 2006;36:3614.
[Google Scholar]

[24] Komolafe M. A., Ogunlade O, Komolafe E. O., . Stroke mortality in a teaching hospital in South Western Nigeria. Trop Doct. 2007;37:186-8.
[Google Scholar]

[25] Kumral E, Ozkaya B, Sagduyu A, Sirin H, Vardarli E, Pehlivan M, . The Ege Stroke Registry: Hospital-based study in Aegean region, Izmir, Turkey. Cerebrovasc Dis. 1998;8:278-88.
[Google Scholar]

[26] Bornstein N. M., Aronovich B. D., Karepov V. G., Gur A. Y., Treves T. A., Oved M, et al . The Tel-Aviv Stroke Registry: The consecutive 3600 patients. Stroke. 1996;27:1770-3.
[Google Scholar]

[27] Moulin T, Tatu L, Crépin-Leblond T, Chavot D, Bergès S, Rumbach T, . Besancom Stroke Registry: An acute stroke registry of 2,500 consecutive patients. Eur Neuro. 1997;38:10-20.
[Google Scholar]

[28] Bak S, Bak L, Sorense J. S., . Prevalence of risk factors in cerebral ischemia. Ugeskr Laeger. 1995;157:444-6.
[Google Scholar]

[29] Nwosu C. M., Nwabueze A. C., Ikeh V. O., . Stroke at the prime of life: A study of Nigerian Africans between the ages of 16 and 45 years. East Afr Med J. 1992;69:384-90.
[Google Scholar]

[30] Onwuchewa A, Bellgam H, Asekomeh G, . Stroke at the university of port harcourt teaching hospital, rivers state, Nigeria. Trop Doct. 2009;39:150-2.
[Google Scholar]

[31] Ong T. Z., Raymond A. A., . Risk factors for stroke and predictors of one-month mortality. Singapore Med J. 2002;43:517-21.
[Google Scholar]

[32] Kumral E, Ozkaya B, Sagduyu A, Sirin H, Vardarli E, Pehlivan M, . et al. Cerebrovasc Dis. 1998;8:278-88.
[Google Scholar]

[33] Anderson C. S., Jamrozik K. D., Broadhurst R. J., Stewart-Wynne E. G., . Predicting survival for 1 year among different subtypes of stroke. Stroke. 1994;25:1935-44.
[Google Scholar]

[34] Bamford J, Dennis M. S., Sandercock P, Burn J, Warlow C, . The frequency, cause and timing of death within 30 days of a first ever stroke: The Oxfordshire Community Stroke Project. J Neurol Neurosurg Psychiatr. 1990;53:824-9.
[Google Scholar]

[35] Stegmayr B, Vinogradova T, Malyutina S, Peltonen M, Nikitin Y, Asplund K, . Widening gap of stroke between East and West. Stroke. 2000;31:2-8.
[Google Scholar]

[36] Jover-Saenz A, Porcel-Perez J. M., Vives-Soto M, Rubio-Caballero M, . Epidemiology of acute cerebrovascular disease in Lleida from 1996-1997. Rev Neurol. 1999;28:941-8.
[Google Scholar]

[37] Mbala-Mukendi M, Tambwe M. J., Dikassa L. N., MBuyamba-Kabangu J. R., . Initial arterial pressure and prognosis of cerebrovascular accidents. Arch Mal Coeur Vaiss. 1995;88:21-5.
[Google Scholar]

[38] Simon W. R., Francis A LM, Robert B. T., . The Relation of Blood Pressure to Stroke Prognosis. Ann Intern Med. 1978;89:15-20.
[Google Scholar]

[39] Mazza A, Pessina A. C., Gianluca P, Tikhonoff V, Pavei A, . Casiglia E Pulse pressure: An independent predictor of coronary and stroke mortality in elderly females from the general population. Blood Press. 2001;10:205-11.
[Google Scholar]

[40] Yang W, Lynette L. Y., Christopher L, Richard F. H., Janet F, . Influence of Hyperglycemia on Stroke Mortality. J Stroke Cerebrovasc Dis. 2001;10:11-8.
[Google Scholar]

[41] Moulin T, Tatu L, Crépin-Leblond T, Chavot D, Bergès S, Rumbach T, . Besancom Stroke Registry: An acute stroke registry of 2,500 consecutive patients. Eur Neuro. 1997;38:10-20.
[Google Scholar]

[42] Thorsten S, Gabriel M, Michael De G, Peter S, Rolf H, Werner H, . Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke. 1997;28:711-5.
[Google Scholar]

[43] Burtin P, Bollaert P. E., Feldmann L, Lelarge P, Bauer P, Larcan A, . Prognosis of patients with stroke undergoing mechanical ventilation. Intensive Care Med. 1994;20:32-6.
[Google Scholar]

[44] Chambers B. R., Norris J. W., Shurvell B. L., Hachinski V. C., . Prognosis of acute stroke. Neurology. 1987;37:221-5.
[Google Scholar]

[45] Bonita R, Ford M. A., Stewart A. W., . Predicting survival after stroke: A three-year follow-up. Stroke. 1988;19:669-73.
[Google Scholar]

[46] Sheikh K, Brennan P. J., Meade T. W., Smith D. S., Goldenberg E, . Predictors of mortality and disability in stroke. J Epidemiol Community Health. 1983;37:70-4.
[Google Scholar]

[47] Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R, . "Malignant› middle cerebral artery territory infarction: Clinical course and prognostic signs. Arch Neurol. 1996;53:309-15.
[Google Scholar]

[48] Smithard D. G., O’Neill P. A., Park C, Morris J, . Complications and outcome after acute stroke - does dysphagia matter? Complications and outcome after acute stroke - does dysphagia matter? Stroke. 1996;27:1200-4.
[Google Scholar]

[49] Gordon C, Hewer R. L., Wade D. T., . Dysphagia in acute stroke. BMJ. 1987;295:411-4.
[Google Scholar]

[50] Barer D. H., . The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry. 1989;52:236-41.
[Google Scholar]

[51] Mann G, Hankey G. J., Cameron D, . Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744-8.
[Google Scholar]

[52] Katzan I. L., Cebul R. D., Husak S. H., Dawson N. V., Baker D. W., . The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology. 2003;60:620-5.
[Google Scholar]

[53] Davenport R. J., Dennis M. S., Wellwood I, Warlow C. P., . Complication after acute stroke. Stroke. 1996;27:415-20.
[Google Scholar]

Factors associated with death and predictors of one.month mortality from stroke in Kano, Northwestern Nigeria

Abstract

ABSTRACT

Keywords

Mortality

Northwestern Nigeria

predictors

stroke

Conflict of Interest

References

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