Factors Influencing In-hospital Mortality in Acute Stroke Patients in a Tertiary Care Hospital in Kolkata, India

Currently there is limited information on mortality after an acute stroke in hospitalised patients. The objective of this study was to identify predictors of in-hospital mortality (30 days) and set out to identify clinical, radiological and co-morbid predictors of early mortality after an acute stroke.

All patients admitted to the hospital diagnosed with acute stroke confirmed by computerized tomography scan were included in the study. We studied the patients by 32 variables (clinical-12, radiological-3, complications-11 and previously handicapped-6).

A total of 440 (232 male and 208 female) patients with acute stroke were included; 262 (59%) ischaemic and 178 (41%) haemorrhagic. Median age was 60 years. Mortality at one month was 26%. Among the 12 clinical variables age, features of raised intracranial tension, poor Glasgow coma score (GCS) were the most influential factors for the prediction of one-month mortality with size of lesion and severity of mass effect being the important radiological predictors. Complications like delayed recovery of consciousness (> 7 days), aspiration pneumonia and new onset acute myocardial infarction/congestive cardiac failure (AMI/CCF) were associated with increased risk for short-term mortality.

Delay in recovery of consciousness, new onset AMI/CCF and aspiration pneumonia were the most significant predictors of mortality. Knowledge of in-hospital mortality predictors is required to improve survival rate after acute stroke.