Factors influencing mortality and functional outcomes among patients with stroke admitted to a tertiary hospital in Eastern Nepal

Abstract

Background: Of all stroke-related mortality, 80% have occurred in developing countries. But there is a paucity of data regarding the mortality and functional outcome among patients with stroke after hospital discharge in the context of Nepal. Therefore, we conducted this study to determine the mortality and functional outcome in patients with stroke and factors associated with these outcomes.

Materials and Methods: We conducted a longitudinal observational study for a period of one year, among patients admitted at B.P. Koirala Institute of Health Sciences who were aged ≥18 years and diagnosed with stroke. Baseline data on clinical-epidemiological profile and risk factors were obtained on admission. All the patients received usual treatment at hospital and they were followed up at 30 days of stroke onset to determine the outcomes (mortality and functional outcomes). Barthel index was used to determine the functional outcome. Chi-square test and Mann-Whitney U test were performed to determine factors influencing the outcome measures at 30 days.

Results: Of the 107 patients, majority were males (55.1%) and had ischemic stroke (86.9%). The mean±SD age was 63±15 years. The common risk factors were smoking (64, 59.8%), hypertension (59, 55.1%) and alcohol consumption (56, 52.3%). The 30 days mortality rate was 30.8%. The factors significantly associated with mortality were age (p=0.005), atrial fibrillation (p=0.043), hypertension(p=0.029), cardiac disease (p=0.026), history of stroke (p=0.015), and modified Rankin scale score <3 (p=0.043). Of the 60 stroke survivors, 60% were independent at 30 days of stroke onset.

Conclusion: The mortality rate at 30 days of stroke onset was relatively higher than stated by earlier studies in Nepal but those who survived had higher functional independence. The factors associated with mortality were mostly modifiable but the functional outcomes were mostly influenced by the disability due to stroke and the extent of impaired consciousness.