Fatores de risco para mortalidade hospitalar após acidente vascular cerebral

Abstract

Introduction: Stroke is the most prevalent neurological disorder in Brazil and worldwide. It is characterized by focal involvement in cerebral blood circulation, leading to sensory, motor, and cognitive alterations. Ischemic stroke (IS) is the most prevalent type, characterized by the interruption of blood flow due to vessel obstruction, resulting in the formation of ischemic areas in the brain and, consequently, temporary or permanent clinical repercussions. Objective: To assess risk factors for in-hospital mortality in patients after IS. Method: This is a prospective cohort study that included patients with a primary diagnosis of IS, admitted within 24 hours of symptom onset, and diagnosed using cranial computed tomography. Data were collected prospectively on a daily basis, actively seeking patients in the hospital's emergency sectors from admission to discharge. Sociodemographic, clinical, previous history, severity, complications, hospitalization, and outcomes variables were analyzed using various statistical methods, including the Mann-Whitney test, Pearson's Chi-square test, Fisher's exact test, and Poisson regression models to evaluate relationships between dependent and independent variables. Results: The study included 91 patients, with 53% females and 47% males, with a mean age of 65 (SD=13.9) years. Regarding IS types and complications, IS without other alterations stood out (84.6%), followed by extensive or malignant IS (9.9%), and lastly, IS with hemorrhagic transformation (5.5%). Concerning reperfusion therapy, the study showed that 22% of patients underwent intravenous thrombolysis, with 44.8% arriving within four hours and 30 minutes of symptom onset. Regarding complications and outcomes during hospitalization, 73.6% were discharged, and 25.3% died in the hospital. Patients with a higher likelihood of in-hospital death were those with malignant or extensive IS (Consciousness Impairment [CI] = 42, p < 0.001), patients with National Institutes of Health Stroke Scale (NIHSS) (CI = 4.89, p = 0.008), absence of bilateral pupillary light reflex (CI = 5.90, p = 0.009), anticoagulant use (CI = 6.84, p = 0.005), respiratory infection (CI = 8.85, p = 0.017), elevated C-reactive protein levels (CI = 248, p < 0.001), need for Intensive Care Unit (ICU) (CI = 25.39, p < 0.001), mechanical ventilation (CI = 138, p < 0.001), and use of hospital neuromuscular blockers (CI = 12.59, p = 0.033). Additionally, patients with Alberta Stroke Program Early Computed Tomography Score between 0 and 5 and NIHSS greater than 16 had a significantly higher odds ratio for in-hospital death. Conclusion: Patients with more severe conditions, greater cerebral involvement, and at least one complication during hospitalization had a higher risk of in-hospital death. Distance did not significantly influence the mortality of IS patients, and not reaching the therapeutic window or not undergoing thrombolysis were not risk factors for death.