Predictors of functional outcome among stroke patients in Lima, Peru.
BACKGROUND
Because of the aging population in low- and middle-income countries, cerebrovascular disease is expected to remain a leading cause of death. Little has been published about stroke in Peru. We conducted a retrospective cohort study of hospitalized stroke patients at a referral center hospital in Lima, Peru to explore factors associated with functional outcome among stroke patients.


METHODS
We identified 579 patients hospitalized for ischemic stroke or intracerebral hemorrhage stroke at the National Institute of Neurologic Sciences in Lima, Peru in 2008 and 2009. A favorable outcome was defined as a modified Rankin scale score of ≤ 2 at discharge.


RESULTS
The mean age was 63.3 years; 75.6% had ischemic stroke; the average duration of stay was 17.3 days. At hospital discharge, 231 (39.9%) had a favorable outcome. The overall mortality rate was 5.2%. In multivariate models, the likelihood of having a favorable outcome decreased linearly with increasing age (P = .02) and increasing National Institutes of Health Stroke Scale (NIHSS) score (P = .02). Favorable outcome was also associated with male gender (relative risk [RR] 1.2; 95% confidence interval [CI] 1.0-1.5) and divorced status (RR 1.3; 95% CI 1.1-1.7). Patients on Salud Integral de Salud (SIS; public assistance-type insurance; RR 0.7; 95% CI 0.5-1.0) were also less likely to have a favorable outcome.


CONCLUSIONS
Favorable outcome after stroke was independently associated with younger age, a lower NIHSS score, male gender, being divorced, and not being on SIS insurance. These findings suggest that additional study of worse functional outcomes in patients with SIS insurance be conducted and confirm the importance of risk adjustment for age, stroke severity (according to the NIHSS scale), and other socioeconomic factors in outcomes studies. Future studies should preferentially assess outcome at 30 days and 6 months to provide more reliable comparisons and allow additional study of Peruvian end-of-life decision-making and care.
Department of Cerebrovascular Disease, National Institute of Neurological Sciences, Lima, Peru.
Carlos
C
Abanto
Thanh G N
TG
Ton
David L
DL
Tirschwell
Silvia
S
Montano
Yrma
Y
Quispe
Isidro
I
Gonzales
Ana
A
Valencia
Pilar
P
Calle
Arturo
A
Garate
Joseph
J
Zunt
D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D020300:Intracranial Hemorrhages / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010568:Peru; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
Functional outcome; Peru; modified Rankin scale; stroke