Case-fatality of acute ischemic stroke in stroke units of Latin American hospitals
Miguel A Vences1, Miguel A Barboza2, Leonardo Augusto Carbonera3
1Universidad César Vallejo, Medicine School. Piura, Perú.
Insights
This study found that acute ischemic stroke (AIS) in Latin America has a 9.42% in-hospital and 10.2% 30-day case-fatality rate. Older age, hyperglycemia, and stroke severity are key predictors of early death.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Acute ischemic stroke (AIS) poses a significant health challenge globally.
- Understanding case-fatality rates and risk factors in specific regions is crucial for targeted interventions.
- Latin America presents unique healthcare system characteristics that may influence stroke outcomes.
Purpose of the Study:
- To determine the in-hospital, 30-day, and 90-day case-fatality rates for AIS patients in Latin American stroke centers.
- To identify demographic, clinical, imaging, and functional factors associated with AIS case-fatality.
- To analyze risk factors predicting early mortality in AIS patients within the region.
Main Methods:
- A multicenter retrospective cohort study was conducted across 27 centers in 11 Latin American countries.
- Data from 2,997 hospitalized AIS patients aged over 18 years were collected between January and December 2022.
- Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for 30-day fatality.
Main Results:
- The in-hospital case-fatality rate was 9.42%, with 10.2% dying within 30 days and 13.3% within 90 days.
- Complications occurred in 31.3% of patients, with infections being the most common (18.5%).
- Significant risk factors for 30-day fatality included older age (>75 years), hyperglycemia, poor baseline status, severe stroke (NIHSS >26), and neurological complications.
Conclusions:
- AIS patients in Latin American stroke centers exhibit substantial in-hospital and 30-day case-fatality rates.
- Older age, hyperglycemia, baseline status, stroke severity, and neurological complications are strong predictors of early mortality.
- Optimizing stroke management protocols in Latin America is essential to improve patient outcomes.
Background And Purpose:
The Case-fatality of acute ischemic stroke in stroke units of Latin American hospitals is a multicenter registry from various stroke centers in Latin America, exploring demographic, clinical, imaging, and functional outcomes in acute ischemic stroke (AIS) patients, with the intention of determining case-fatality rates (in-hospital, 30 and 90 days follow up) and analyzing associated risk factors.
Methods:
We conducted a retrospective cohort study using data from hospitalized AIS patients over 18 years of age, collected from 27 centers in 11 Latin American countries between January 1 and December 31, 2022. The effect size was estimated using the hazard ratio (HR) and 95 % confidence intervals (95 % CI) through Cox regression models to assess the association between time to 30-day fatality event and covariates.
Results:
A total of 2,997 patients were included. The mean age was 68.7 years and 48.1 % were women. In-hospital case-fatality was 9.42 %, 277 patients (10.2 %) died within 30 days, and 90-day case-fatality was relatively close at 353 patients (13.3 %). Complications were reported in 31.3 % of cases, most frequently infections (18.5 %). Age over 75 years (HRa=2.28), hyperglycemia (HRa=1.28), baseline status (HRa=1.61), stroke severity according to NIHSS >26 (HRa=6.11) and the presence of neurological complications (HRa=3.2) were risk factors for 30-day follow up case-fatality in these patients.
Conclusion:
AIS patients in Latin America stroke centers had an in-hospital case-fatality of 9.42 % and the 30-day case-fatality was 10.2 %. Older age, hyperglycemia, baseline status, stroke severity and neurological complications were the strongest predictors of early case-fatality. The findings underscore the need to optimize stroke management protocols in the region.
