Risk factors, mortality and recovery of Stroke: A prospective study on 1000 Patients

摘要

Objective: To determine whether a single or multiple risk factors have a relative significance on the mortality and morbidity of stroke and whether previous treatment of major risk factors like hypertension and diabetes mellitus had any positive influence on the clinical outcome. Methodology: One thousand consecutive cases of acute stroke were included in this prospective descriptive study conducted at the Dept. of Neurology, Jinnah Postgraduate Medical Centre, Karachi from Dec. 1985 to July 1988. A special proforma was designed to collect all the relevant clinical information. Functional status was assessed by using the Barthel Index activity score. Scores obtained at admission were compared with the scores obtained at six weeks follow-up. The results were then analyzed in the background of various risk factors present. Similar observations were made in assessing the mortality. The pre-stroke treatment status of major risk factors like hypertension and diabetes mellitus was also studied. Results: Of the 1000 cases, 61% were male and 39% female. Majority of the cases were in the age group 60-69 years. Hypertension (HTN) alone was present in 58.3% followed by diabetes mellitus (DM) 5%, ischemic heart disease (IHD) 1.3%, whereas in 19.8% HTN, DM, IHD were present in various combinations, 1.5% had Valvular Heart Disease (VHD) while 14.1% had none of the above risk factors. Six-weeks follow-up was available on (673/1000) 67% cases. Gross mortality was 59% (396/673). Higher mortality was seen in cases with Glasgow Coma Scale (GCS) range 3-9/15. Risk factor profile in fatal cases showed that 221/379 (58%) had HTN, 21/32 (65%) had DM, 6/12 (50%) had IHD and 6/10 (60%) had Valvular heart disease (VHD). Some patients had multiple risk factors, among those 60/95 (63%) had HTN + DM, 19/41 (46%) had HTN + IHD, 5/7 (71%) had DM+ IHD, 11/16 (68%) had HTN + DM + IHD while 47/81 (58%) had none of the above risk factors. Relative influence of individual risk factor or in combination was not statistically significant. The functional recovery showed no significant relative difference among patients with different risk factors. There was no significant difference in the outcome among treated and untreated hypertensive and diabetic patients. Conclusions: Individual or multiple risk factors do not have a relative influence on the higher morbidity and mortality in stroke. For poor prognosis severity of stoke at onset is more important than the type of risk factors. Furthermore, there was no difference in outcome in patients who got pre-stroke treatment compared to those who had no treatment.