Stroke characteristics and 30-day mortality among young adults in Kiruddu and Mulago Hospitals

Abstract

Background The incidence of stroke in young adults over the past decades has increased, and two million young adults suffer a stroke each year. This trend may reflect the various risk factors among young adults. Stroke in young adults is associated with severe disease and disability, leading to very high Disability-adjusted life years (DALYs) due to its occurrence at a prime age. Most mortality studies focus on the general population and not young adults specifically. Study Objective: In this study, we determined the proportion of young adults among patients with stroke admitted in KNRH and MNRH, the clinical-laboratory characteristics, and the thirty-day mortality outcome with associated factors. Methods: A prospective observational study was conducted at Mulago and Kiruddu National Referral Hospitals from March 2022 to June 2022. Of 195 patients with confirmed stroke, 61 young adults who met inclusion criteria participated in the study. Questionnaires extracted data on socio-demographics, clinical and laboratory characteristics, and 30-day mortality outcomes. Sociodemographic characteristics included; age, sex, marital status, alcohol and smoking history, and family history of stroke. The clinical features included; presenting complaints, stroke severity at admission (National Institutes of Health Stroke Scale (NIHSS), level of consciousness (Glasgow Comma Scale,GCS), and level of disability (modified Rankin Scale,mRs). The Laboratory characteristics included fasting, random blood glucose levels, white cell count, haemoglobin, and HIV status. Patient characteristics were summarized using descriptive statistics; median and interquartile range for continuous variables and proportions and frequencies for categorical variables. Fisher’s exact test was done to compare characteristics by stroke subtypes because of the small sample size. Factors associated with mortality were determined using modified Poisson regression since the proportion of participants who died was >10%. Kaplan–Meier survival curves were used to show survival probability after 30 days and a log rank test was done to check for significance between the two groups. Results Of 195 screened stroke patients, 61 (31.3%) were young adults (95% CI 7.5%-71.6%). Of 61 young adult stroke patients, 40/61 (65.6%) were male, 35/61 (57.4%) had an ischaemic stroke, and 26/61 (42.6%) had a haemorrhagic stroke. Regarding risk factors, 29/61 (47.6%) were known hypertensives, 26/61 (42.6%) had a history of alcohol consumption, with 95% alcohol dependent (CAGE ≥1). About 6/61 (9.8%) had a smoking history and 10/61 (17.5%) had a positive family history of stroke. Of 21 females, 6 (28.6%) females had a history of oral contraception use.. Clinically, the majority presented with symptom onset within three days; more than half (33/61, 54.1%), had severe strokes (NIHSS >16) at admission. Nearly 2/3 (45/61, 73.8%) had significant disability (mRs 3-6). Regarding mortality, 14/61 (23.3%) (95% CI: 0.010, 0.901) died within 30 days of stroke symptom onset. Smoking (aPR-5.094, 95% CI: 3.712, 6.990), not drinking alcohol (aPR-7.247, 95% CI: 4.491, 11.696), and severe stroke NIHSS >16 (PR-3.301, 95%CI: 1.395, 7.808) were associated with mortality at multivariate analysis. Being single (PR-0.785, 95% CI: 0.583, 1.056) was associated with mortality in bivariate and not multivariate analysis. From the Kaplan–Meier curve, most deaths occurred in the first ten days of stroke symptom onset.

Conclusion A third of all stroke patients who presented at the two Ugandan national referral hospitals were young adults, and more than half had severe strokes. About 23.3% died within 30 days of stroke onset, and severe stroke, smoking, and not taking alcohol were associated with mortality.