Predictors of In-Hospital Mortality Among Patients With Acute Stroke: Insights From the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database.

BACKGROUND

Acute stroke (cerebral infarction) is a leading cause of morbidity and mortality worldwide, with patient outcomes influenced by demographic factors, comorbidities, and hospital characteristics. This study examines the differences in baseline characteristics, comorbidities, and hospital-related factors between survivors and non-survivors of acute stroke.

METHODS

This study analyzed the 2023 Nationwide Readmission Database (NRD) data to identify predictors of in-hospital mortality in acute stroke (cerebral infarction). Patients were identified using the International Classification of Diseases, 10th Revision (ICD-10) codes, and exclusions included missing data, December admissions, and 30-day readmissions. Multivariable logistic regression assessed mortality risk factors, adjusting for demographics, comorbidities, and hospital characteristics (p < 0.05).

RESULTS

Non-survivors had a significantly higher median age (73 years vs. 71 years, p < 0.001) and included a slightly higher proportion of women (48.8% vs. 47.2%, p < 0.001). The prevalence of comorbidities, including cardiac arrest (11.9% vs. 0.7%), heart failure (35.1% vs. 0.7%), and respiratory failure (71.2% vs. 11.7%), was markedly higher among non-survivors (p < 0.001 for all). Hospitalization costs were significantly greater for non-survivors ($122,763.67 vs. $56,497, p < 0.001), and the length of stay was longer (seven days vs. four days, p < 0.001). Most admissions occurred in private non-profit hospitals, with large hospitals treating a higher proportion of non-survivors (p < 0.001).

CONCLUSION

The study highlights critical factors influencing stroke mortality, including advanced age, cardiovascular and metabolic comorbidities, and hospital resource utilization. These findings emphasize the need for early risk stratification, targeted intervention strategies, and equitable healthcare access to improve survival rates among high-risk stroke patients.