Determinants of early case-fatality among stroke patients in Maputo, Mozambique and impact of in-hospital complications

The burden of stroke is increasing in developing countries that struggle to manage it efficiently. We identified determinants of early case-fatality among stroke patients in Maputo, Mozambique, to assess the impact of in-hospital complications. Patients admitted to any hospital in Maputo with a new stroke event were prospectively registered (n=651) according to the World Health Organization's STEPwise approach, in 2005-2006. We assessed the determinants of in-hospital and 28-day fatality, independently of age, gender and education, and computed population attributable fractions. In-hospital mortality was higher among patients with Glasgow score at admission ≤6 (more than fivefold) or needing cardiopulmonary resuscitation during hospitalization (approximately 2·5-fold). Pneumonia and deep vein thrombosis/other cardiovascular complications during hospitalization were responsible for 19·6% (95% confidence interval, 5·3 to 31·7) of ischaemic stroke and 15·9% (95% confidence interval, 5·8 to 24·9) of haemorrhagic stroke deaths until the 28th day. Ischaemic stroke patients with systolic blood pressure 160-200mmHg had lower in-hospital mortality (relative risk=0·32, 95% confidence interval, 0·13 to 0·78), and, for those with haemorrhagic events (haemorrhagic stroke), 28-day mortality was higher when systolic blood pressure was over 200mmHg (hazard ratio=3·42; 95% confidence interval, 1·02 to 11·51), compared with systolic blood pressure 121-140mmHg. Regarding diastolic blood pressure, the risk was lowest at 121-150mmHg for ischaemic stroke and at 61-90mmHg for haemorrhagic stroke. Early case-fatality was mostly influenced by stroke severity and in-hospital complications. The allocation of resources to the latter may have a large impact on the reduction of the burden of stroke in this setting. © 2013 World Stroke Organization.