Impact of Medical and Neurological Complications on Intra-Hospital Mortality of Stroke in a Reference Hospital in Ouagadougou (Burkina Faso)

Introduction: Medical and neurological complications occurring at the acute stroke stage are frequent and increase post-stroke mortality. Their prevention, early recognition, or effective management in stroke units, should contribute to a significant reduction in early post-stroke deaths. The purpose of our study was to assess the impact of the medical and neurological complications observed at the acute stroke phase, on intra-hospital mortality of strokes.

Patients and Methods: It was a prospective, transversal, descriptive and analytical, hospital study, from 01/11/2015 to 31/10/2016, at Tingandogo University Hospital Centre, in Ouagadougou, Burkina Faso. The study concerned patients aged > 16 years, consecutively hospitalized for ischemic or hemorrhagic stroke, occurred less than 72 hours of hospitalization, confirmed with the brain scan, after informed consent of patients or members of their families.

Socio-demographic characteristics, vascular risk factors, comorbidities, clinical, neuroradiological and biological data at admission and intra-hospital evolutionary data were analyzed. A univariate, then multivariate, logistic regression analysis was performed between the various medical and neurological complications observed during hospitalization, at acute stroke phase (independent variables), and intrahospital deaths (dependent variable), to investigate the impact of these medical and neurological complications on intra-hospital mortality.

Results: We have consecutively collected 197 patients. The average age of the patients was 61.1 years old. The majority of patients (63.3%) were male. At the admission, 19 patients (9.6%) were in coma, the average NIHSS was 16.7.There were 129 cases of cerebral infarction (65.5%) and 68 cases of hemorrhagic stroke (34.5%). Fever (56.9%), pulmonary infection (42.6%), cardiac complications (25.9%), malnutrition (22.8%), malaria access to Plasmodium falciparum (17.3%), urinary tract infection (16.2%), were the most common medical complications. Neurological complications were represented by neurological deterioration (36%) and epileptic seizures (15.2%), respectively. The intra-hospital mortality rate was 25.9%. At the end of the multivariate analysis with logistic regression, pulmonary infection (OR 4.41; 95% CI [1,171-16,619]; p = 0,028) and neurological deterioration (OR 29.11; 95% CI [8,009-105,844]; p = 0,000) were the only predictive independant medical and neurological complications of intra-hospital post-stroke death.

Conclusion: Medical and neurological complications remain frequent at the acute stroke phase, causing a high intra-hospital mortality of about 26%. Post stroke pulmonary infection and neurological deterioration are the independent predictive complications of intra-hospital deaths. The use of therapeutics to reduce the size and severity of stroke, including fibrinolysis, control of physiological parameters and homeostasis within SU, would allow a significant reduction in early post stroke mortality.