Objectives: The present study analyzed in-hospital first-time stroke mortality in\nsouthwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality\nrate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based\nfollow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over\none-year period (January through December 2016) were included in the study. Data about personal\ncharacteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital\ncomplications and survival status were collected. The last reported Aseer region population was\nused to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios\n(HR) and concomitant 95% confidence intervals (95% CI) were computed using multivariate Cox\nregression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted.\nResults: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall\ncase fatality rate (CFR) of 9.7%. Non-significant difference with gender and age were observed in\nCFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed\na significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke\nsmoking (HR = 2.36), pre-stroke hypertension (HR = 1.77), post-stroke disturbed consciousness\n(HR = 6.86), poor mobility (HR = 2.60) and developing pulmonary embolism (HR = 2.63) as significant\npredictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital\nstroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could\nbe improved by smoking cessation, better control of hypertension and prevention of in hospital\ncomplication particularly pulmonary embolism.
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