Assessment of the Prevalence, Risk Factors and Outcomes of Large Vessel Occlusion Strokes at the University Teaching Hospitals, Lusaka, Zambia
Musisye Luchembe1, Aparna Nutakki2, Melody Asukile1, Sarah Braun1, Lorraine Chishimba1, Mashina Chomba3, Meron Gebrewold4, Mataa Mataa1, Dominique Mortel5, Mulenga Chilando1, Dickson Munkombwe1, Frighton Mutete6, Naluca Mwendaweli1, Coolwe Namangala1, Faith Simushi1, Stanley Zimba1, Deanna Saylor2
1University Teaching Hospital, 2Johns Hopkins Hospital, 3University of Zambia, 4Addis Ababa University, 5Phoebe Neurology, 6Livingstone University Teaching Hospital
Objective:
To determine the in-hospital prevalence, risk factors, and clinical outcomes of large vessel occlusion strokes (LVOs) at UTH in Lusaka, to identify opportunities for improved acute ischemic stroke management in Zambia.
Background:
Stroke burden is rising in Africa, and LVOs, the commonest type of ischemic stroke, have the worst outcomes. Timely intervention improves clinical outcomes. Zambia, like many countries in sub-Saharan Africa, lacks acute ischemic stroke interventions such as thrombolysis and mechanical thrombectomy.
Design/Methods:
We conducted a longitudinal prospective cohort study of adults with acute stroke (< 7 days) admitted to the largest hospital in Zambia from 2019 to 2022. Demographic, clinical, neuroimaging and outcome data were collected. Descriptive statistics are reported, and associations evaluated using chi-square tests or Fischer’s exact tests as appropriate. Multivariable logistic regression models predicted factors associated with mortality in LVOs.
Results:
Of 256 ischemic stroke patients, 64% (n=163) were LVOs. Overall, mean+SD age was 59+17, and 58% were female. Demographic factors (age, sex) and stroke risk factors were similar between those with and without LVOs. Including hypertension (90%), diabetes (23%), hyperlipidemia (19%), previous stroke (17%) and heart disease (29%). However, the National Institutes of Health Stroke Scale (NIHSS) was significantly higher for LVOs than other ischemic strokes (mean+SD, 16+11 vs 11+8, p<0.001), and modified Rankin Scale scores were worse for LVOs (median (IQR), 4(4,5) vs 4(3,5), p=0.009). In-hospital mortality was higher in LVOs (21% vs 10%, p=0.02). In multivariable analyses, advanced age (OR=1.02, 95% CI 1.004,1.08), higher NIHSS (OR=1.13, 95% CI 1.02,1.26) and tobacco use (OR=5.85, 95%CI 1.36,25.2) were independent predictors of mortality in LVOs.
Conclusions:
LVO strokes were the commonest ischemic stroke sub-type in this cohort. They were more severe and associated with higher in-hospital mortality, especially in the elderly. Acute ischemic stroke services are urgently needed to improve stroke outcomes in Zambia.
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