Predictors of short term mortality after acute stroke in East Azerbaijan Province, 2014

Abstract

Background and Purpose: one of the major causes of death and disability in Iran is stroke. Stroke is responsible for 7.5 million deaths annually, which is nearly equivalent to 9.9% of the total deaths constituted stroke. However, about 85 percent of the deaths were occurred in low and middle-income countries. The aim of this study was to calculate the one-month mortality and factors affecting the mortality in patients with a first stroke in East Azerbaijan province. Method: This study is a prospective study from sub-categories observational studies which was carried out from December 2013 to April 2014. The study was based on hospital design. The subjects of the study included patients with a definitive diagnosis of ischemic and hemorrhagic stroke were in Razi and Imam Reza hospitals in Tabriz, East Azerbaijan province is the only referral center for individuals. The interested variables were included in this study: 1- Demographic characteristics: age, sex, education level, occupation, body mass index (BMI), marital status; 2- Some risk factors of stroke: blood glucose, cholesterol, triglycerides, systolic and diastolic blood pressure at admission, HDL, LDL, hyperlipidemia, history of smoking (cigarettes or more a day for Passive), tobacco and alcohol, birth control pills, diabetes and heart disease. Stroke as a sudden onset of focal symptoms with the distribution of brain function over 24 hours. Descriptive statistics of patients with statistical markers for quantitative variables by default normality such as mean (SD) and median and inter quartile range in the normal lack of qualitative variables with the frequency (relative frequency) were presented. The Chi-square test was used to assess a probable statistically significant difference between qualitative variables for limitations on the observed frequency of Fisher's exact test. For compare the equality of two mean values in qualitative variables and default equality of variances of student's t-test exam was used. Data analyzed by SPSS software version 19. P-value less than 0.05 were considered as a significant level. Result: During the period of study, 409 participants with an average age of first stroke 81.68 and standard deviation 80.12 that the age range of patients between 21 and 96 years . Statistically significant difference between the average age of males 68.71 (12.62) and women 68.95 (13.06) was observed p-value= 0.85). Men comprised the 229 (56.0) of the strokes and male to female ratio in the population was 1.27. The highest proportionate of job category in women's gender was house-keeper 175 (97.2) and in men, other 67 (29.50) and agriculture 31 (13.7). The average age of died persons at 30 days interval was 73.97 (10.88) and survivors was 67.40 (12.94), and statistically significant differences were observed between the average age of survivors and deceased (p- value=0.001). By increasing the severity stroke the short mortality of strokes in the 30-day follow-up found a significant increase. As well as the lowest DEATH at 30-day follow-up time belonged to NIHSS less than 5, and the highest mortality strokes in 30-day follow-up time belonged to NIHSS-15-19 and 20. No statistically significant difference was observed in NIHSS of men; stroke severity and frequency of stroke in men was higher than to women ( p-value= 0.001).The factors predictors of death in univariate analysis: age, stroke type, stroke severity index (NIHSS), smoking, diabetes, LDL and HDL increased mortality risk. It’s most on short-term mortality of stroke severity, age and the type of stroke. In the multivariate analysis, per year increase in the average age at the same time with the implementation of other variables on 30-day mortality relative risk of stroke increased 5% [relative risk with 95% of 1.05 and 1.031.08] per unit increased severity of stroke relative risk of stroke by 11 percent 30-day mortality [relative risk of 1.11 and 95% of 1.08-1.14] and damping the relative risk of ischemic stroke, hemorrhagic than 137% more [relative risk with 95% of 2.37 and 1.41-3.96] as predictor variables damping short-term (30-day), respectively. Conclusion: Findings of this study showed that the affecting factors on short-term mortality (30 days) were old age (the mean age), hemorrhagic stroke, stroke severity NIHSS (15-19 and 20) of the most effective factors on short-term mortality in the multivariate analysis.