Treatment outcome and risk factors of ischemic stroke among adult patients in two selected hospital in Addis Ababa, Ethiopia

Abstract

• (Risk Factors and Treatment Outcomes of Ischemic Stroke Among Adult Patients in Two Selected Hospitals in Addis Ababa, Ethiopia: A Cross-Sectional Study) • The majority (61.19%) of ischemic stroke patients were aged 60 years or older, with a mean age of 61.7 years. • Hypertension (61.19%), dyslipidemia (49%), and diabetes mellitus (46.12%) were the most common comorbidities among ischemic stroke patients. • 94.06% of patients arrived at the hospital after the critical 4.5-hour window, and none received thrombolytic therapy. • 80.82% of patients had poor functional outcomes (Modified Rankin Scale score of 3–6), and the in-hospital mortality rate was 20.55%. • Older age (≥60 years), delayed hospital arrival (≥4.5 hours), low Glasgow Coma Scale (GCS ≤8) at presentation, prior stroke history, and prolonged hospital stay were identified as independent predictors of poor outcomes. • Strengthening early recognition, rapid hospital presentation, and comprehensive management of risk factors is crucial to improve ischemic stroke outcomes in Ethiopia. Ischemic stroke remains a major cause of morbidity and mortality worldwide, with a growing burden in low- and middle-income countries such as Ethiopia. Identifying risk factors, clinical profiles, and outcomes is crucial for improving stroke prevention strategies. A retrospective cohort study was conducted from September 2023 to December 2024 at two public hospitals in Addis Ababa. Data was collected from 219 adult ischemic stroke patients through structured interviews and detailed chart reviews. Sociodemographic characteristics, comorbidities, and outcomes were analyzed. Multivariable logistic regression analysis was used to identify predictors of poor functional outcomes, defined as a mRS score of 3–6. The mean age of patients was 61.7 years, with 61.19% aged 60 years or older. Hypertension (61.19%), dyslipidemia (49%), and diabetes mellitus (46.12%) were the most common comorbidities. A significant proportion (94.06%) arrived at the hospital after 4.5 hours of symptom onset, and none received thrombolytic therapy due to unavailability. Poor outcomes (mRS 3–6) were significantly associated with age ≥60 years (AOR=4.8, 95% CI:2.67-8.32, p < 0.001), delayed hospital arrival (AOR = 2.92, CI:1.41-4.38, p = 0.03), and Glasgow Coma Scale score ≤8 (AOR = 4.5, CI:2.2-9.2, p = 0.001), prior stroke history (AOR=1.88, CI:1.1-3.28, p=0.03), and prolonged hospital stay over seven days (AOR=2.1, CI:1.1-4.12, p=0.02). The overall in-hospital mortality rate was 20.55%. Advanced age, delayed hospital presentation, low GCS at presentation, prior stroke history, and prolonged hospital stay were independent predictors of poor outcomes among ischemic stroke patients. Strengthening early detection programs, ensuring timely hospital access, expanding thrombolytic therapy availability, and targeting modifiable risk factors are critical strategies to improve stroke outcomes in Ethiopia.