In-hospital survival and predictors of mortality among stroke patients at a tertiary hospital in Ghana: A retrospective cohort study

Abstract

INTRODUCTION: Stroke is a leading cause of death and disability worldwide. In Ghana, national estimates show a prevalence of 7.9% and an incidence rate of 1.2%, placing a significant burden on the health system. This study aimed to estimate in-hospital survival rates and identify predictors of mortality among stroke patients admitted to Tamale Teaching Hospital (TTH). METHODS: A retrospective electronic medical records review was conducted using data from the Lightwave Health Information Management System (LHIMS) and patients' registry from January 1 2021 to December 31 2023. Kaplan-Meier survival curve was used to determine the survival rate of stroke patients (mean follow-up: 67 days). Cox proportional hazard regression determined the association between risk factors and survival time. Crude and adjusted hazard ratios with 95% confidence intervals were presented. A p-value of 0.05 was considered statistically significant. RESULTS: A total of 998 stroke patients were included, of which 39.4% died. The overall survival rate was 21% at the end of follow-up (182 days). The survival probability for female stroke patients was lower compared to males. Female sex (AHR = 1.33, 95% CI: 1.07-1.65), Dagomba ethnicity (AHR = 1.31, 95% CI: 1.05-1.62), pneumonia (AHR = 1.59, 95% CI: 1.27-1.97), diabetes mellitus (AHR = 0.62, 95% CI: 0.47-0.82), systolic blood pressure ≥ 130 mmHg (AHR = 1.35, 95% CI: 1.06-1.73), and temperature ≥ 37.5°C (AHR = 1.79, 95% CI: 1.37-2.33) were predictors of mortality. CONCLUSION: Female stroke patients experienced higher mortality and lower survival compared to males. The identified mortality predictors underscore the importance of focused interventions to enhance survival outcomes at TTH. Given the retrospective design and possible unmeasured confounders, the lower mortality risk among diabetic patients should be interpreted with caution, and prospective studies are warranted to confirm these associations.