Preditores de mortalidade intra-hospitalar após o acidente vascular cerebral isquêmico: uma revisão integrativa

Abstract

INTRODUCTION: Ischemic stroke (ISC) is the second leading cause of mortality worldwide, resulting in disabilities, irreversible sequelae and a negative impact on quality of life. OBJECTIVE: Identify the risk factors associated with hospital mortality after ischemic stroke available in the literature. METHOD: This is an integrative review of studies published between 2008 and 2024. This review followed the CHARMS checklist (CheckList for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies), in addition to the PICOTS strategy, Population (P): individuals over 16 years of age with a primary diagnosis of ischemic stroke; Index test (I): clinical data, in addition to laboratory and imaging tests; Comparator (C): not applicable; Outcome (O): mortality; Timing (T): in-hospital; Setting (S): observational, prospective or retrospective cohort and case-control studies. Studies published in Portuguese, Spanish or English, observational studies (cohort or case-control) available in the PubMed, Scopus, Web of Science, Embase, Lilacs, Google Scholar, Open Grey and Trove databases were included. The search was carried out in the PubMed, Scopus, Web of Science, Embase, Lilacs, Google Scholar, Open Grey and Trove databases. RESULTS AND DISCUSSION: A total of 17,008 articles were identified, of which 16,826 were excluded, 4,755 due to duplication and 12,071 for not meeting the eligibility criteria after reading the titles and abstracts. After reading the articles in full (n=180), 25 articles were selected and included in the review. The included studies identified that the presence of comorbidities (such as hypertension, diabetes and atrial fibrillation), complications such as bronchoaspiration pneumonia, laboratory alterations (such as increased RDW and lactate) and time to response to treatment were risk factors associated with in-hospital mortality after ischemic stroke. In addition, they highlight the importance of advanced age and score on the National Institutes of Health Stroke Scale as predictors of unfavorable outcomes in these patients. CONCLUSION: This study emphasizes the importance of early identification of predictors of hospital mortality in patients with ischemic stroke, showing that clinical factors and patient severity negatively impact the outcome.