Predicting factors of poor outcome of hemorrhagic stroke patients

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND 2019. Background: Stroke is the leading cause of morbidity and mortality, accounting for a significant and increasing share of hospital costs in Thailand. Objective: The purpose of the present research was to study predicting factors of poor outcome at the time of discharge of hemorrhagic stroke (HS) patients, who underwent treatment in Chiang Mai University Hospital. Materials and Methods: A five-year cross-sectional retrospective study was conducted. The subjects of the present study were patients diagnosed with HS, 15 years and older, admitted to Chiang Mai University Hospital between January 2009 and December 2013. The modified Rankin Scale (mRS) at the time of discharge was used to classify the patient outcomes. The good outcome group (mRS of less than 4) and poor outcome (mRS of 4 or more) were compared. Predictors of poor outcomes consisting of demographic data and known risk factors were identified through multiple regression analysis. Results: Six hundred forty-seven patients with HS underwent treatment during the study period. At the time of discharge, 431 (66.6%) of patients had poor outcome and 328 (50.9%) had to be transferred back to a secondary hospital. The significant predictors of poor outcome by multivariate analysis were Glasgow Coma Score (GCS) at admission of 8 or less (adj OR 12.6, 95% CI 7.2 to 22.1), infection (adj OR 2.7, 95% CI 1.7 to 4.2), male gender (adj OR 1.9, 95% CI 1.3 to 2.9), operative treatment (adj OR 2.0, 95% CI 1.3 to 3.0), hypertension (adj OR 2.1, 95% CI 1.2 to 3.6), hyperlipidemia (adj OR 1.0, 95% CI 0.9 to 1.0), and ICH (adj OR 1.6, 95% CI 1.0 to 2.4). Conclusion: The major finding from the present study was that two-thirds of the patients had poor outcomes. Hospital acquired infection must be screened and detected promptly. Health education may improve patient outcomes by promoting self-awareness in HS patients such as complying with antihypertensive medicine and controlling cholesterol within the normal limits.