Nakibuuka Jane, Sajatovic Martha, Nankabirwa Joaniter, Ssendikadiwa Charles, Furlan Anthony J, Katabira Elly, Kayima James, Kalema Nelson, Byakika-Tusiime Jayne, Ddumba Edward
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7051, Kampala, Uganda.
Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106 USA.
Springerplus. 2015 Aug 25;4:450. doi: 10.1186/s40064-015-1252-8. eCollection 2015.
Identification of early outcomes post stroke and their predictors is important in stroke management strategies. We prospectively analysed 30-day outcomes (mortality and functional ability) after stroke and their predictors among patients admitted within 7 days post event to a national referral hospital in Uganda. This was a prospective study of acute stroke patients consecutively enrolled between February and July 2014. Social demographics, clinical, laboratory, imaging characteristics, outcomes (all through 30 days), time of death were assessed using standardised questionnaires. Multiple regression was used to analyse the independent influence of factors on outcomes. Of 127 patients, 88 (69.3 %) had ischemic stroke and 39 (30.7 %) had hemorrhagic stroke. Eight (6.3 %) died within 7 days, 34 (26.8 %) died within 30 days, with 2/3 of deaths occurring in hospital. Two were lost to follow up. Of 91 survivors, 49 (53.9 %) had satisfactory outcome, 42 (46.1 %) had poor functional outcome. At multivariate analysis, independent predictors of mortality at 30 days were unconsciousness (GCS <9), severe stroke at admission and elevated fasting blood sugar. None of the patients with functional independence (Barthel index ≥60) at admission died within 30 days. Inverse independent predictors of satisfactory outcome at 30 days were older age, history of hypertension and severe stroke at admission. Acute stroke patients in Uganda still have high rates of early mortality and poor functional outcomes. Independent predictors of mortality and poor functional outcome were severe stroke at admission, unconsciousness, high fasting blood sugar, old age and history of hypertension.
识别卒中后的早期结局及其预测因素对卒中管理策略至关重要。我们对乌干达一家国家级转诊医院事件发生后7天内入院的患者进行了卒中后30天结局（死亡率和功能能力）及其预测因素的前瞻性分析。这是一项对2014年2月至7月连续纳入的急性卒中患者的前瞻性研究。使用标准化问卷评估社会人口统计学、临床、实验室、影像学特征、结局（均为30天内）、死亡时间。采用多元回归分析因素对结局的独立影响。127例患者中，88例（69.3%）为缺血性卒中，39例（30.7%）为出血性卒中。8例（6.3%）在7天内死亡，34例（26.8%）在30天内死亡，其中2/3的死亡发生在医院。2例失访。91例幸存者中，49例（53.9%）结局良好，42例（46.1%）功能结局不佳。多因素分析显示，30天死亡率的独立预测因素为昏迷（GCS<9）、入院时重度卒中及空腹血糖升高。入院时功能独立（Barthel指数≥60）的患者在30天内均未死亡。30天结局良好的反向独立预测因素为年龄较大、高血压病史及入院时重度卒中。乌干达的急性卒中患者早期死亡率仍较高，功能结局不佳。死亡率和功能结局不佳的独立预测因素为入院时重度卒中、昏迷、空腹血糖高、年龄大及高血压病史。
