Incidence and predictors of mortality among stroke patients with aspiration pneumonia in western amhara during the 2023 to 2024 armed conflict

Abstract

Aspiration pneumonia, a severe lung infection caused by inhaling endogenous flora or gastrointestinal contents, is a leading cause of mortality following a stroke. It often results from impaired swallowing, allowing substances to enter the lungs, especially in those with weakened cough reflexes. This compromises respiratory defenses, leading to pulmonary complications like aspiration pneumonia and acute respiratory distress syndrome, significantly increasing morbidity and mortality in stroke patients. Despite improvements in care, aspiration pneumonia remains a significant epidemiological and prognostic challenge for stroke patients, leading to heightened rates of mortality. To investigate the incidence, clinical outcomes, and predictors of mortality among stroke patients with aspiration pneumonia admitted to specialized hospitals in Western Amhara during the 2023/2024 armed conflict. A retrospective follow-up study was conducted with 191 patients from June 1, 2024, to August 30, 2024. Data were extracted from patient charts and entered into EpiData version 4.2, with statistical analysis performed using STATA version 17. Kaplan-Meier survival curves were employed to estimate survival probabilities, and the log-rank test was used to compare survival curves across different covariates. Adjusted hazard ratios with 95% confidence intervals were calculated to assess associations, with variables showing a p-value < 0.05 in multivariable analysis considered statistically significant. The study revealed a mortality rate of 23.56% among stroke patients who developed aspiration pneumonia, equivalent to 15.63 deaths per 100 person-Days, with a median survival time of 6 days. Patients with random blood sugar levels ≥ 200 mg/dL faced a 5.68-fold higher risk of mortality, while those who did not receive nasogastric tube therapy were 5.42 times more likely to die compared to those who did. This study highlights the significant burden of aspiration pneumonia in stroke patients. Key risk factors include elevated blood sugar levels and increased mortality risk, while nasogastric tube therapy offers protective benefits. Early interventions are crucial to reduce nasogastric tube impact and improve survival.