In-Hospital Acute Ischemic Stroke Case Fatality: Experience from a University Hospital in Bogota, Colombia (2018-2019).
Abstract
Camilo Romero, Silvia Bueno, Camila Castellanos and Nicolas Molano
Introduction Until 2020, stroke was the second cause of death in Colombia and worldwide. In-hospital case fatality accounts for the majority of deaths. Multiple risk factors for in-hospital mortality have been described in the stroke population and their recognition could reduce stroke-related death.
Aims To describe a single center experience of in-hospital acute ischemic stroke case fatality and its risk factors.
Methodology Single center, retrospective, cross-sectional study between august 2018 and august 2019. Admitted consecutive patients with acute ischemic stroke brain infarct type were included. Admission sociodemographic, clinical, laboratory and imaging studies variables were drawn out. Quantitative variables were summarized as means, medians and interquartile ranges. Bivariate analysis was used to evaluate associations of in-hospital stroke case fatality and imputed variables.
Results 402 stroke brain infarct type patients were included, mean age 73,28 years (SD±14,53), 50,4% men. Prevalent vascular risks factors were hypertension (70,90%), diabetes mellitus type 2 (24,13%) and previous stroke (20,90%). There were 13 (3,2%) in-hospital case fatalities. Mean time from admission to death was 11.38 days (SD±10,8). Lower hemoglobin levels (p=0.002), lower total, LDL and HDL serum cholesterol levels (p=0.02), internal carotid artery stenosis >50% by duplex ultrasound (p=0.01) and stroke severity as measured by NIHSS score (p<0,0001) showed association with in-hospital stroke case fatality.
Conclusions NIHSS score, hemoglobin level, and cholesterol (total, LDL, HDL) levels upon admission may be used by clinicians to make the appropriate early transfer decisions to facilities with the capacity to offer advance in-hospital stroke care. The cholesterol paradox in acute stroke fatality warrants further studies.