In-Hospital Mortality among Ischemic Stroke Patients in Gondar University Hospital: A Retrospective Cohort Study.
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ABSTRACT:
SUBMITTER: Gebreyohannes EA
PROVIDER: S-EPMC6332873 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
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Project description:Background:Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital. Methods:Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients' charts and registration books, and analyzed using Stata 14 software. Kaplan-Meier failure curve and Log r?ank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P? 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model. Results:A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2-8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30-10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48-4.51)), jaundice (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86-5.73)). Conclusion:The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.
| S-EPMC7102893 | biostudies-literature
Project description:Background/Objectives: Understanding the prognostic factors of acute ischemic stroke (AIS) is essential for improving patient outcomes. The aim of this study was to establish the predictive role of plasmatic resistin and leptin on short-term mortality in adult patients with a first episode of AIS. Methods: This study enrolled 277 patients who were consecutively hospitalized for AIS. Demographic data, cardiovascular risk, comorbidities, and laboratory tests were collected. Death was noted if it occurred during hospitalization. Results: Death was recorded in 33 (11.9%) patients. Conducting multivariate analysis, the following variables were independent variables associated with in-hospital mortality: a resistin value of >11 ng/mL (OR 10.81 (95%CI 2.31;50.57), p = 0.002), a lesion volume of >18.8 mL (OR 4.87 (95%CI 1.87;12.67), p = 0.001), a NIHSS score of >7 (OR 5.88 (95%CI 2.01;17.16), p = 0.001), and the presence of IHD (OR 4.33 (95%CI 1.66;11.27), p = 0.003). This study has some limitations: single-center design (which may affect the generalizability of the results) and the potential impact of the COVID-19 pandemic on patient outcomes. Conclusions: This study demonstrated that resistin is a significant predictor of in-hospital mortality in AIS patients. Other established factors, such as a high NIHSS score, large lesion volume, and the presence of IHD, were reaffirmed as important predictors.
| S-EPMC11355181 | biostudies-literature
Project description:IntroductionRecently, stroke is becoming the major public health problem in developing countries including Ethiopia. Atrial fibrillation patients are the most vulnerable group for the occurrence of stroke. Knowing the predictors and being aware for it is important for preventing severe complications and death. Therefore, the aim of this study is to assess the prevalence of stroke and identifying significant predictors.MethodsA hospital-based cross-sectional study was performed from 1 December 2018 to 30 September 2019 at University of Gondar Referral Hospital. A total of 242 patients with atrial fibrillation were included in the study. Atrial fibrillation patients were diagnosed by using 12 lead electrocardiographic tracing, in addition to thorough medical history and physical examination and analyzed by the Modular ECG Analysis System (MEANS). We used Epi info 7 and SPSS version 22 software for data entry and analysis purpose, respectively. Both bivariable and multivariable binary logistic regression model were computed to show the relationship of dependent and independent variables.ResultThe prevalence of stroke among atrial fibrillation patients was 19.4% (95% confidence interval (CI): 14.9-25.2). Patients with heart failure (adjusted odds ratio (AOR): 5.70, 95% CI: 2.50-13.24) and thyroid disorder (AOR: 4.98, 95% CI: 1.47-16.85) are at risk of developing stroke.ConclusionThe prevalence of stroke was higher compared with others studies. Patients with heart failure and thyroid disorders were the risk factor for the development of stroke; therefore, physicians and cardiologists may better to consider all these two disorders when they diagnose stroke in patients with atrial fibrillation.
| S-EPMC7841671 | biostudies-literature
Project description:BACKGROUND:Epilepsy is the most common chronic neurologic disorder which affects an estimated 10.5 million children worldwide. Despite the burden, the scarcity of study held in Ethiopia. Hence, the aim of this study was to assess the treatment outcomes of epilepsy and its root causes in children with epilepsy. METHODS:A hospital-based retrospective cohort study was conducted from October 10/2017 up to October 10/2018. A total of 210 study participants who fulfilled the eligibility criteria were included in the study. A structured interviewer-administered questionnaire with a document review was used to collect data. The data were entered into Epi Info version 7.2.1 and analyzed using SPSS version 21. Descriptive statistics were computed. Simple logistic analysis was run (at 95% CI and p-value < 0.05) to identify factors associated with treatment outcome. RESULT:210 eligible patients with epilepsy were recruited for the study. About half of the respondents were females and the majority was within the age group of 5-10 years. Phenobarbital has been the most frequently prescribed drugs and thirteen percent of patients were in the escalation phase of treatment. Eight percent of the study participants had poor adherence to the treatment regimen. About six percent of the study subjects were suffering from an uncontrolled seizure. Being a female child (AOR = 2. 21; 95%CI: 1.11, 4.41) and excellent adherence to anti-epilepsy treatment (AOR = 4. 51; 95%CI: 1.53, 13.42) were significantly associated with treatment outcome. CONCLUSION:This study revealed that many children were suffering from uncontrolled seizure and escalation therapy is being exercised. Being a female child and adherence to anti-epilepsy treatment were significantly associated with treatment outcome. Therefore, attention should be given to adherence counseling to convey a better treatment outcome.
| S-EPMC7067446 | biostudies-literature
Project description:BackgroundAnemia is the most common hematologic abnormalities in AIDS patients usually associated with disease progression and poor clinical outcomes. Zidovudine (AZT), which is one of the nucleoside reverse transcriptase inhibitor drug families of the first line antiretroviral therapy regimen for HIV/AIDS patients, causes anemia due to early long-term of higher-dose therapy. This study was aimed to assess the magnitude and associated factors of anemia among AZT containing HAART experienced adult HIV/ADIS patients at University of Gondar Comprehensive Specialized Referral Hospital, northwest, Ethiopia, 2019.MethodsA retrospective cohort study was conducted among a total of 320 adult AZT based HAART experienced HIV/AIDS patients from January 2016 to December 2018. Systematic random sampling technique was used to select the patients' charts. All required data for this study were extracted from patients' medical charts. Data were coded, cleared and entered into Epi Info version 3.5.3, and transformed to SPSS version 20 for analysis. Descriptive statistics, bivariable and multivariable logistic regression models were fitted to identify associated factors of anemia and P-value < 0.05 was considered as statistically significance.ResultsA total of 320 adult AZT based HAART experienced HIV/AIDS patients' charts were assessed. Of the total patients, 198 (61.9%) were females and 133 (41.6%) were within the age range of 35-45 years. More than half, 237(76.9%) of the patients were from the urban area and 186 (58.1%) were on WHO clinical stage III at the baseline. The prevalence of anemia was 50% (95% CI 44.7-55.0%), 44.1% (95% CI 38.4-50.0%), 35.6% (95% CI 30.3-40.6%), 40% (95% CI 34.4-45.6%), 40.6% (95% CI 35.0-46.3) and 39.1% (95% CI 33.4-44.1%) at baseline, 6 months, 12 months, 18 months, 24 months and 30 months of follow-up period, respectively. The overall prevalence of anemia was 41.6%. Anemia had significant association with WHO clinical stage and base line Hgb values.ConclusionsA significant number of participants were anemic in this study. WHO clinical stage and baseline Hgb value were the contributing factors for anemia among these patients. Therefore, anemia needs an immediate intervention on associated factor to improve the anemic status and living condition of HIV patient.
| S-EPMC8480035 | biostudies-literature
Project description:BackgroundPost-stroke care delivery may be affected by provider participation in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) through systematic changes to discharge planning, care coordination, and transitional care.ObjectiveTo evaluate the association of MSSP with patient outcomes in the year following hospitalization for ischemic stroke.DesignRetrospective cohort SETTING: Get With The Guidelines (GWTG)-Stroke (2010-2014) PARTICIPANTS: Hospitalizations for mild to moderate incident ischemic stroke were linked with Medicare claims for fee-for-service beneficiaries ≥ 65 years (N = 251,605).Main measuresOutcomes included discharge to home, 30-day all-cause readmission, length of index hospital stay, days in the community (home-time) at 1 year, and 1-year recurrent stroke and mortality. A difference-in-differences design was used to compare outcomes before and after hospital MSSP implementation for patients (1) discharged from hospitals that chose to participate versus not participate in MSSP or (2) assigned to an MSSP ACO versus not or both. Unique estimates for 2013 and 2014 ACOs were generated.Key resultsFor hospitals joining MSSP in 2013 or 2014, the probability of discharge to home decreased by 2.57 (95% confidence intervals (CI) = - 4.43, - 0.71) percentage points (pp) and 1.84 pp (CI = - 3.31, - 0.37), respectively, among beneficiaries not assigned to an MSSP ACO. Among discharges from hospitals joining MSSP in 2013, beneficiary ACO alignment versus not was associated with increased home discharge, reduced length of stay, and increased home-time. For patients discharged from hospitals joining MSSP in 2014, ACO alignment was not associated with changes in utilization. No association between MSSP and recurrent stroke or mortality was observed.ConclusionsAmong patients with mild to moderate ischemic stroke, meaningful reductions in acute care utilization were observed only for ACO-aligned beneficiaries who were also discharged from a hospital initiating MSSP in 2013. Only 1 year of data was available for the 2014 MSSP cohort, and these early results suggest further study is warranted.RegistrationNone.
| S-EPMC6854149 | biostudies-literature
Project description:BackgroundStroke data from Sierra Leone is limited, despite the increase in global burden of the disease. The aim of this study was to assess the risk factors, clinical outcomes and predictors of stroke mortality at a tertiary hospital in Freetown, Sierra Leone.MethodsThis retrospective cohort study was conducted on stroke patients admitted at the Connaught Teaching Hospital between 1st January to December 31, 2018. Clinical data related to stroke, with variables including patients' demographics, stroke subtype, vascular risk factors, modified Rankin Scale (mRS), and outcomes were documented. In-hospital mortality, associated risk factors and predictors of stroke were determined. The study was approved by the Sierra Leone Ethics and Scientific Review Committee. It was registered under Research Registry https://www.researchregistry.com/browse-the-registry#home/with the unique identifying number researchregistry6009.ResultWe studied 178 (95 male and 83 female) patients. The mean age was 59.8 ± 14.0 years, median was 58.1years (ranging: 29-88 years). The commonest risk factors were hypertension (84.3%), tobacco smoking (35.9%) and alcohol (31.4%). Ischemic stroke confirmed by CT scan was 76.3%. In-hospital mortality was 34.8% and at discharge, mean modified Rankin Score (mRS) was 3.89 ± 1.62. The independent predictors for stroke mortality were: hypertension [AOR = 2.2; C.I 95%: (1.32-3.80), p = 0.001], previous stroke [AOR = 2.31; C.I 95%: (1.43-5.74), p = 0.001], GCS < 8 [AOR = 6.06; C.I 95%: (3.17-12.79), p < 0.001], clinical diagnosis in the absence of imaging [AOR = 3.11; C.I 95%: (2.1-9.87), p = 0.001], hemorrhagic stroke [AOR = 2.96; C.I 95%: (1.96-9.54), p < 0.001], and aspiration pneumonia [(AOR = 3.03; C.I 95%:(1.44-6.36), p = 0.001]. Women had poorer outcome than men.ConclusionThis study highlights a high stroke mortality in a resource limited hospital, with some stroke patients having difficulties in accessing Computer Tomogram (CT) scan services. It illustrates the need to establish a stroke care setting to improve the quality of stroke care.
| S-EPMC7649580 | biostudies-literature
Project description:BackgroundThe emergency department (ED) sensitive hospital standardized mortality ratio (ED-HSMR) measures risk-adjusted mortality for patients admitted to hospital with conditions for which ED care may improve health outcomes. This study aimed to describe in-hospital mortality across Canadian provinces using the ED-HSMR.MethodsHospital discharge data were analyzed from April 2009 to March 2012. The ED-HSMR was calculated as the ratio of observed deaths among patients with emergency-sensitive conditions in a hospital during a year (2010-11 or 2011-12) to the expected deaths for the same patients during the reference year (2009-10), multiplied by 100. The expected deaths were estimated using predictive models fitted from the reference year. Aggregated provincial ED-HSMR values were calculated. A HSMR value above or below 100 respectively means that more or fewer deaths than expected occurred within a province.ResultsDuring the study period, 1,335,379 patients were admitted to hospital in Canada with an emergency-sensitive condition as the most responsible diagnosis. More in-hospital deaths (95% confidence interval) than expected were respectively observed for the years 2010-11 and 2011-12 in Newfoundland [124.3 (116.3-132.6); & 117.6 (110.1-125.5)] and Nova Scotia [116.4 (110.7-122.5) & 108.7 (103.0-114.5)], while mortality was as expected in Prince Edward Island [99.9 (86.5-114.8) & 100.7 (87.5-115.3)] and Manitoba [99.2 (94.5-104.1) & 98.3 (93.5-103.3)], and less than expected in all other provinces and territories.ConclusionsOur study revealed important variation in risk-adjusted mortality for patients admitted to hospital with emergency-sensitive conditions among Canadian provinces. The ED-HSMR may be a useful outcome indicator to complement existing process indicators in measuring ED performance.Trial registrationN/A - Retrospective cohort study.
| S-EPMC6805639 | biostudies-literature
Project description:BACKGROUND: The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. METHODS AND RESULTS: Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CONCLUSIONS: CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.
| S-EPMC4020787 | biostudies-literature
Project description:Low-dose aspirin is recommended to reduce the risk of cardiovascular disease. However, the questions with regard to primary prevention have been raised among patients with diabetes. We evaluated low-dose aspirin use for preventing ischemic stroke in patients with diabetes using a national health insurance database.Using data from the Korean Health Insurance Review and Assessment Service database from January 1, 2005, through December 31, 2009, a population-based retrospective cohort study was conducted with incident patients with diabetes aged 40 to 99 years old with the initial use of low-dose aspirin during the index period from January 1, 2006 to December 31, 2007. We matched each low-dose aspirin user to one non-user using a propensity score. The Cox proportional hazards model was used to compare the risk of hospitalization for ischemic stroke in users and nonusers of low-dose aspirin until December 31, 2009.Out of 261,065 incident patients with diabetes, 15,849 (6.2%) were low-dose aspirin users. Compared to non-users, the adjusted hazard ratio (95% confidence interval) of low-dose aspirin users for hospitalization due to ischemic stroke was 1.73 (95% CI; 1.41-2.12). In a sensitivity analysis of study subjects with more than 1 year follow-up periods, slightly higher adjusted hazard ratio (1.97, 95% CI; 1.51-2.62) was observed. In the subgroup analyses, there were no significant changes in the risk of hospitalization for ischemic stroke irrespective of gender, age, or comorbidity.In this study of patients with diabetes, the use of low-dose aspirin showed an increased risk of hospitalization for ischemic stroke. These results suggest that low-dose aspirin use for the primary prevention of ischemic stroke should be reconsidered in patients with diabetes.
| S-EPMC4346109 | biostudies-other