Predictors of early hospital mortality in patients with ischemic stroke

Objective: Identifying predictors that forecast hospital mortality among patients with ischemic stroke is crucial for ensuring timely and appropriate treatment and for improving its outcomes.The aim of this study was to investigate predictors associated with early hospital mortality in patients with ischemic stroke.We examined the relationship between various clinical, laboratory, and neuroimaging factors and adverse clinical outcomes.Methods: This retrospective, cohort study, included the analysis of medical records of 90 patients aged 18 and older diagnosed with "ischemic stroke," who were admitted to the stroke unit of a large tertiary-level multi-profile hospital.All patients were divided into two groups -the deceased group (n=45) and the surviving group (n=45).The collected data included patients' demographic information, basic clinical and laboratory characteristics upon admission to the hospital, historical data on vascular risk factors, neuroimaging findings (including angiography), as well as cardiological evaluations, consultations with specialists, and autopsies.The association of predictors with clinical outcome of ischemic stroke was determined using multivariate logistic regression analysis.Results: In the deceased group, hospital mortality was associated with the initial severity of the condition due to reduced consciousness (n=31 (69%), p<0.001), a short hospital stay (n=27 (60%), p<0.001), unstable hemodynamics and respiratory failure (n=25 (55.5%), p<0.001), necessitating the use of mechanical ventilation (n=20 (44.4%), p<0.001) and a urinary catheter insertion (n=45 (100%), p<0.001), hypercreatinemia (238 (232) mmol/L, p<0.05), hyperglycemia (n=23 (51.1%), p<0.001), and hyperthermia (n=20 (44.4%), p<0.001), as well as signs of increasing brain edema with manifestations of displacement (n=17 (37.7%), p<0.001).The results of multiple logistic regression analysis showed that hypoxemia, tachycardia/bradycardia, atherothrombotic stroke, cerebral edema with dislocation of the stredin structures according to neuroimaging data were the most significant predictors of the risk of death in the group of deceased individuals (p<0.05). Conclusions:The results of multiple logistic regression analysis showed that hypoxemia, atherothrombotic stroke, creatinine level were the most significant predictors of the risk of death in patients with ischemic stroke.Cerebral edema with dislocation of the stredin structures according to neuroimaging data had borderline predictive value.Our results emphasize the importance of risk stratification of fatal outcomes, monitoring intracranial pressure and its reduction in case of compression threat, vital organ parameters, screening, and preventive treatment of early extracerebral hospital complications (cardiorespiratory and renal).More aggressive control of vascular risk factors, including hypertension, diabetes, and hyperlipidemia at the pre-hospital level, serves as prevention not only for stroke itself but also for its complicated forms, ultimately affecting the frequency of ischemic stroke and mortality from it.