Clinical presentation, risk factors, and outcomes of stroke in Shabwah Governorate, Yemen

Abstract

Background: There is a lack of reliable information on stroke risk factors, clinical presentation, and mortality. The aim of this study was to describe stroke risk factors, clinical presentations, and in-hospital mortality and to identify the independent predictors of mortality among stroke patients admitted to three hospitals in Shabwa Governorate, Yemen. Methods: This retrospective and cross-sectional study was conducted from July 1, 2022, to June 30, 2023, in three hospitals in Shabwah Governorate, namely, Shabwah General Hospital Authority, Al Shifa Specialized Hospital, and Afya Specialized Hospital. Results: We involved 124 stroke cases, of whom 92 (74.2%) were males and 32 (25.8%) were females. Their mean age was 64.98±16.22 years, and hypertension was the most common risk factor, accounting for 71.0% (n=88) of cases. Ischemic stroke was detected in 95 (76.6%) cases, intracerebral hemorrhage (ICH) was detected in 25 (20.2%) patients, and subarachnoid hemorrhage (SAH) was detected in 4 (3.2%) cases. The in-hospital mortality was 27(21.8%), and according to bivariate analysis, the in-hospital mortality was significantly associated with hypertension (p=0.015), diabetes mellitus (DM) (p<0.0001), ischemic heart disease (p=0.002), rheumatic heart disease (p<0, 0001), and cardiomyopathy (p=0.004). In addition, in-hospital mortality was significantly associated with coma (p<0.0001), ischemic stroke (p<0.0001), ICH (p=0.013), and SAH (p=0.032). However, in multivariate logistic regression analysis, only coma (adjusted odds ratio [OR]=11.21, 95% confidence interval [CI]=3.42–36.75, p<0.0001) and DM (adjusted OR=5.8, 95% CI=1.79–18.85, p=0.003) were found to be independent risk factors for in-hospital mortality. Conclusion: In Shabwah Governorate, Yemen, ischemic strokes were more common than hemorrhagic strokes, with men more likely to have a stroke than women and the majority of cases being elderly. DM and coma were found to be independent risk factors for in-hospital mortality. Therefore, appropriate treatment of DM and other vascular risk factors is recommended to improve stroke outcomes.