Survival of Stroke Patients According to Hypertension Status in Northern Ethiopia: Seven Years Retrospective Cohort Study

Figures & data

Table 1 Socio-Demographic Characteristics of First Ever-Adult Stroke Patients Admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia, 2012–2019 (n=503)

Baseline Variables		Exposure Category		Total	P-value (χ^2)
		Hypertensive	Non-Hypertensive
		Frequency (%)	Frequency (%)	Frequency (%)
Age (years)	<45	44(8.7)	30(6.0)	74(14.7)	0.1
	45–54	40(8.0)	14(2.8)	54(10.8)
	55–64	68(13.5)	31(6.2)	99(19.7)
	65–74	87(17.3)	45(8.9)	132(26.2)
	75–84	64(12.7)	38(7.6)	102(20.3)
	≥85	20(3.9)	22(4.4)	42(8.3)
Sex	Female	162(32.2)	89(17.7)	251(49.9)	0.88
	Male	161(32)	91(18.1)	252(50.1)
Religion	Orthodox	96 (19.1)	62(12.3)	158(31.4)	0.43
	Muslim	29(5.8)	15 (2.9)	44(8.7)
	Catholic	3 (0.6)	0	3(0.6)
	Unrecorded ^a	195(38.8)	103 (20.5)	298(59.3)
Residence	Urban	199(39.6)	86 (17.1)	285(56.7)	0.01*
	Rural	114 (22.7)	88 (17.5)	202 (40.2)
	Unrecorded ^a	10 (1.9)	6 (1.2)	16(3.1)
Ethnicity	Tigrian	281(55.9)	159(31.6)	440(87.5)	0.85
	Afar	12(2.4)	7(1.4)	19(3.8)
	Others ^ǂ	8(1.6)	5(0.9)	13(2.5)
	Unrecorded ^a	22(4.4)	9(1.8)	31(6.2)

Notes: ^aImplies if the particular variable was not documented in the patient’s medical record, ǂImplies Amhara, Philippians (there was one non-Ethiopian patient), *Implies that patients were not comparable based on their place of residence (urban/rural).

Table 2 Neurological Characteristics of First-Ever Adult Stroke Patients Admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia, 2012–2019

Patient Profile	Response	Exposure Category		Total	P-value (χ^2)
		Hypertensive	Non-Hypertensive
		Frequency (%)	Frequency (%)	Frequency (%)
Type of stroke identified (n=503).	IS	137 (27.2)	148 (29.4)	285 (56.6)	<0.001*
	HS	180 (35.8)	29 (5.8)	209 (41.6)
	SAH	6 (1.2)	3 (0.6)	9 (1.8)
Etiologic subtypes of Ischemic stroke (n=285)	Cardio-embolic	30 (10.5)	39 (13.7)	69 (24.2)	0.53
	LAA	8 (2.8)	13 (4.6)	21 (7.4)
	SAO	33 (11.5)	29 (10.2)	62 (21.7)
	Unclassified ^a	66 (23.2)	67 (23.5)	133 (46.7)
Causes of HS (n=209)	Hypertension	177 (84.6)	1(0.5)	178 (85.1)	<0.001*
	Others ^§	1 (0.5)	4 (2)	5 (2.5)
	Unclassified ^b	2 (1)	24 (11.4)	26 (12.4)
Clinical presentation at admission (multiple clinical presentations were possible) (n=503).	Coma	85 (16.9)	44 (8.7)	129(25.6)	0.65
	Aphasia	145 (28.8)	82 (16.3)	227 (45.1)	0.89
	Hemiparesis	253 (50.3)	144 (28.6)	397(78.9)	0.67
	Hemiplegia	24 (4.8)	15 (3)	39 (7.8)	0.72
	CN palsy	44(8.7)	28 (5.6)	72 (14.3)	0.55
	Headache	127 (25.2)	47(9.3)	174(34.5)	0.3
	Vomiting	125 (24.8)	37 (7.4)	162 (32.2)	0.19
	Others ^ǂǂ	22 (4.4)	10(2)	32(6.4)	0.56
GCS at admission (n=503).	3–8	61 (12.1)	32 (6.4)	93 (18.5)	0.45
	9–12	111 (22.1)	72 (14.3)	183 (36.4)
	13–15	151 (30)	76 (15.1)	227 (45.1)

Notes: ^aIndicates for ischemic stroke subtypes not classified according to Trial of Org 10,172 in Acute Stroke Treatment classification, ^bIndicates for those causes of hemorrhagic stroke which were not further classified, ^§Indicates for Amyloid Angiopathy, Vascular aneurism, and anticoagulant related causes, ^ǂǂIndicates vertigo, abnormal body movement, fecal and urinary incontinences, *Implies that patients were not comparable based on their type of stroke and causes of Hemorrhagic stroke using Fisher’s exact test.

Abbreviations: CN, cranial nerve; GCS, Glasgow Coma Scale; HS, hemorrhagic stroke; IS, ischemic stroke; LAA, large artery atherosclerosis; SAH, sub-arachnoid hemorrhage; SAO, small artery occlusion.

Table 3 Stroke Event Factors^† at Admission Among First-Ever Adult Stroke Patients Admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia, 2012–2019

Patient Profile	Categories	Exposure Category		Total	P-value (χ^2)
		Hypertensive	Non-Hypertensive
		Frequency (%)	Frequency (%)	Frequency (%)
Time from stroke onset to hospital arrival (in hours)	>6	308(61.2)	175(34.8)	483(96)	0.31
	Others^a	15(3)	5(1)	20(4)
	Total	323 (64.2)	180(35.8)	503 (100)
Timing of brain imaging done (in hours)	≤3	0	1(0.2)	1(0.2)	0.18
	>3	323(64.2)	179(35.6)	502(99.8)
	Total	323 (64.2)	180(35.8)	503 (100)
Length of hospital stay (in days)	1–7	117(23.3)	55(10.9)	172(34.2)	0.42
	7–14	125(24.9)	78(15.5)	203(40.4)
	≥14	81(16.1)	47(9.3)	128(25.4)
	Total	323 (64.3)	180(35.7)	503 (100)
Presence of stroke Complications	Yes	152(30.2)	84(16.7)	236(46.9)	0.93
	No	171(34)	96(19.1)	267(53.1)
	Total	323 (64.2)	180(35.8)	503 (100)
Types of stroke complications detected (a patient can have more than one complication)	Aspiration Pneumonia	115(22.9)	68(13.5)	183(36.4)	0.63
	Increased ICP	45(8.9)	13(2.6)	58(11.5)	0.24
	UTI	25(5)	13(2.6)	38(7.6)	0.83
	DVT	10(2)	9(1.8)	19(3.8)	0.28
	Seizure	18(3.6)	7(1.4)	25(5)	0.41
	Others^#	15(3)	4(0.8)	19(3.8)	0.55
Platelet count (cells/mm^3)	<150,000	37(7.4)	24(4.8)	61(12.13)	0.21
	150–450,000	269 (53.5)	140(27.8)	409(81.31)
	>450,000	17(3.3)	16(3.2)	33(6.56)
	Total	323(64.2)	180(35.8)	503(100)
Serum creatinine (mg/dL) (n=491)	≤ 1.6	296 (60.3)	164(33.4)	460(93.7)	0.99
	>1.6	20(4.1)	11(2.2)	31(6.3)
	Total	316(64.4)	175(35.6)	491(100)

Notes: ^†Hypertensive and non-hypertensive adult stroke patients were comparable by all of the acute stroke event factors (P-value was non-significant in all of the event factors), ^aIncludes those patients who present to the hospital within 3 hours, 3 to 4.5 hours and 4.5 to 6 hours of stroke symptoms onset, ^#Includes Gastro-intestinal bleeding, Myocardial infarction, hypokalemia, hypocalcemia, and bedsore.

Abbreviations: DVT, deep venous thrombosis; ICP, increased intracranial pressure; UTI, urinary tract infection.

Table 4 Kaplan – Meier Estimate of Survivor Function Among First Ever-Adult Stroke Patients Admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia, 2012–19

Exposure Status	Time (Days)	Beginning Total	Fail	Survivor Function	Std. Error	95% CI
Hypertensive	2	301	17	0.95	0.01	0.92, 0.97
	7	206	39	0.87	0.02	0.82, 0.90
	10	136	6	0.83	0.02	0.78, 0.87
	14	81	3	0.81	0.03	0.75, 0.86
	28	14	1	0.80	0.03	0.73, 0.85
Non-hypertensive	2	163	14	0.92	0.02	0.87, 0.95
	7	125	18	0.89	0.02	0.84, 0.94
	10	78	1	0.89	0.03	0.83, 0.93
	14	47	2	0.85	0.03	0.76, 0.91
	28	9	3	0.73	0.08	0.55, 0.85

Figure 1 Kaplan–Meier survival curve based on exposure status among first ever-adult stroke patients admitted in Ayder comprehensive specialized hospital, Northern Ethiopia, 2012–2019.

Figure 2 Kaplan–Meier survival curve based on admission Glasgow Coma Scale among first ever-adult stroke patients admitted in Ayder comprehensive specialized hospital, Northern Ethiopia, 2012–2019.

Figure 3 Kaplan–Meier survival curve based on the development of stroke complications among first ever-adult stroke patients admitted in Ayder comprehensive specialized hospital, Northern Ethiopia, 2012–2019.

Figure 4 Kaplan–Meier survival curve based on total cholesterol level among first ever-adult stroke patients admitted in Ayder comprehensive specialized hospital, Northern Ethiopia, 2012–2019.

Table 5 Bivariate and Adjusted Predictors of Mortality Among First-Ever Adult Stroke Patients Admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia, 2012–2019

Covariates		Survival Status		CHR	P-value		AHR	95% CI	P-value
		Dead (%)	Censored (%)
Age (in years)	<45	13(2.6)	61(12.1)	1(base)
	45–54	10(2)	44(8.7)	1.12	0.79		1.05	0.15,7.41	0.96
	55–64	24 (4.8)	75(14.9)	1.51	0.24		1.41	0.25,8.04	0.70
	65–74	17(3.4)	115(22.8)	0.83	0.60		1.74	0.34,8.91	0.51
	75–84	7 (1.4)	95(18.9)	0.41	0.06		0.12	0.01,1.69	0.12
	≥85	4 (0.8)	38(7.6)	0.68	0.5		0.67	0.05,8.64	0.76
Sex	Male	39(7.8)	213(42.3)	1(base)
	Female	36(7.2)	215(42.7)	0.91	0.7
Residence (n=487)	Urban	51(10.5)	234(48)	1(base)
	Rural	22(4.5)	180(37)	0.6	0.04		0.82	0.31, 2.13	0.68
Ethnicity (n=472)	Tigrian	67(14.2)	373(79.1)	1(base)
	Non-Tigrian	4(0.8)	28(5.9)	0.74	0.56
Hypertension	No	24(4.8)	156(31)	1(base)
	Yes	51(10.1)	272(54.1)	1.17	0.52^¶		2.13	0.66,6.81	0.2
Type of stroke	Ischemic	35(6.9)	250(49.7)	1(base)
	Hemorrhagic	37(7.4)	172(34.2)	1.47	0.11		0.71	0.26,1.96	0.51
	SAH	3(0.6)	6(1.2)	3.32	0.05		0.83	0.08,8.16	0.87
Sub-type of IS (n=152)	SAO	9(5.9)	53(34.9)	1(base)
	CE	6(3.9)	63(41.5)	0.7	0.51
	LAA	4(2.6)	17(11.2)	1.3	0.67
Causes of HS (n=183)	Hypertension	30(16.4)	148(80.9)	1(base)
	Non-hypertension	3(1.6)	2(1.1)	4.45	0.01
Duration of symptoms	< 6	4(0.8)	16(3.2)	1(base)
	≥ 6	71(14.1)	412(81.9)	0.63	0.37
GCS at admission	13–15	9(1.8)	218(43.4)	1(base)
	3–8	48(9.5)	45(8.9)	16.55	<0.001	10.12		2.58,40.68	0.001*
	9–12	18(3.6)	165(32.8)	2.45	0.03	1.75		0.44,7.3	0.44
Stroke complications	No	11(2.2)	256(50.9)	1(base)
	Yes	64(12.7)	172(34.2)	6.3	<0.001	7.23		1.86,28.26	0.004*
Total cholesterol (n=449)	Normal	40(8.9)	296(65.9)	1(base)
	Borderline	14(3.1)	55(12.3)	1.71	0.09		3.57	1.15, 11.1	0.03*
	High	11(2.4)	33(7.4)	2.2	0.02		1.57	0.31, 7.96	0.58
Platelet count (cells/mm^3)	Normal	57(11.3)	352(70)	1(base)
	<150,000	11(2.2)	50(9.9)	1.29	0.44		1.52	0.39,5.83	0.55
	>450,000	7(1.4)	26(5.2)	1.63	0.22		1.07	0.13, 9.15	0.95
Creatinine level (n=491)	≤1.6	64(13)	396(80.7)	1(base)
	>1.6	8(1.6)	23(4.7)	1.82	0.11		0.25	0.02,2.49	0.24
Global test ^‡ P(PH) =0.22

Notes: ^¶This variable was significant in the previous study conducted in Saudi Arabiya, we included in the final model even though (P >0.25), *Shows significant difference at P<0.05, ^‡P-value of Schoenfeld residuals for assessing Cox proportional hazards assumption.

Abbreviations: AHR, adjusted hazard ratio; CE, cardio-embolic; CHR, crude hazard ratio; CI, confidence interval; GCS, Glasgow Coma Scale; HS, hemorrhagic stroke; LAA, large artery occlusion; SAH, subarachnoid hemorrhage; SAO, small artery occlusion.