Impact of Medical Comorbidities and In-Hospital Complications on Clinical Outcomes in Stroke Patients: A Prospective Cohort Study at University of Lahore Teaching Hospital, Pakistan
DOI:
https://doi.org/10.61919/jhrr.v6i3.1991Keywords:
stroke; comorbidity; pneumonia; cardiac complications; clinical outcome; tertiary care hospital; Pakistan; ischemic stroke; cohort study.Abstract
Background: Stroke outcomes are substantially influenced by baseline medical comorbidities and the development of acute in-hospital complications. Limited prospective evidence from tertiary-care settings in Pakistan has evaluated the combined impact of chronic disease burden and hospital-acquired complications on short-term stroke outcomes. Objective: To evaluate the association of medical comorbidities and in-hospital complications with clinical outcomes among hospitalized stroke patients at University of Lahore Teaching Hospital, Pakistan. Methods: This prospective cohort study included 87 hospitalized patients with acute stroke. Demographic characteristics, stroke subtype, baseline comorbidities, Charlson Comorbidity Index, polypharmacy, in-hospital complications, cardiac events, and discharge outcomes were recorded. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated to assess predictors of poor clinical outcome. Results: The mean age was 72.8 ± 11.6 years, and 55.2% of patients were female. Ischemic stroke accounted for 92.0% of cases. Hypertension (80.5%), chronic kidney disease (40.2%), and diabetes mellitus (31.0%) were the most prevalent comorbidities. Pneumonia developed in 42.5% of patients, while 50.6% experienced at least one in-hospital medical complication. Poor clinical outcome occurred in 35.6%, and in-hospital mortality was 10.3%. Cardiac events demonstrated the strongest association with poor outcome (RR 4.90, 95% CI 2.10–11.45; p < 0.001), followed by any medical complication (RR 3.85, 95% CI 1.95–7.60; p < 0.001) and pneumonia (RR 3.42, 95% CI 1.76–6.65; p < 0.001). Charlson Comorbidity Index ≥2 and diabetes mellitus were also significantly associated with adverse outcomes. Conclusion: Acute in-hospital complications, particularly cardiac events and pneumonia, were major predictors of poor clinical outcome among hospitalized stroke patients. Early recognition and multidisciplinary management of medical complications may improve stroke outcomes in tertiary-care settings
Downloads
References
Appelros P, Matérne M, Jarl G, Arvidsson-Lindvall M. Comorbidity in stroke survivors: prevalence and associations with functional outcomes and health. J Stroke Cerebrovasc Dis. 2021;30(9):106000. doi:10.1016/j.jstrokecerebrovasdis.2021.106000
Elamy A, Shuaib A, Carriere K, Jeerakathil T. Common comorbidities of stroke in the Canadian population. Can J Neurol Sci. 2020;47(4):455-463. doi:10.1017/cjn.2020.17
Barow E, Probst A, Pinnschmidt H, Heinze M, Jensen M, Rimmele DL, et al. Effect of comorbidity burden and polypharmacy on poor functional outcome in acute ischemic stroke. Clin Neuroradiol. 2022;32(4):1021-1030. doi:10.1007/s00062-022-01193-8
Chen W, Li D. Comorbidity and outcomes among hospitalized patients with stroke: a nationwide inpatient analysis. Front Neurol. 2023;14:1217404. doi:10.3389/fneur.2023.1217404
Simats A, Liesz A. Systemic inflammation after stroke: implications for post-stroke comorbidities. EMBO Mol Med. 2022;14(8):e16269. doi:10.15252/emmm.202216269
Che F, Wang A, Ju Y, Liu L, Ma N, Cheng Z, et al. Prevalence and impact of medical complications on clinical outcomes in acute ischemic stroke patients after endovascular therapy: data from a comprehensive stroke unit in China. World Neurosurg. 2023;181:e563-e571. doi:10.1016/j.wneu.2023.11.113
Duncan P, Bushnell C, Sissine ME, Coleman SW, Lutz B, Johnson AM, et al. Comprehensive stroke care and outcomes. Stroke. 2020;51(9):2732-2738. doi:10.1161/STROKEAHA.120.029678
Buckley B, Harrison S, Hill A, Underhill P, Lane D, Lip GYH. Stroke-heart syndrome: incidence and clinical outcomes of cardiac complications following stroke. Stroke. 2022;53(5):1759-1768. doi:10.1161/STROKEAHA.121.037316
Huber CC, Wang X, Wang H. Impact of cardiovascular diseases on ischemic stroke outcomes. J Integr Neurosci. 2022;21(5):138. doi:10.31083/j.jin2105138
Ayub MA, Ansari J, Sheikh M, Elsekaily O, Buchhanolla P, Neshatfar A, et al. Association of co-morbidities with functional outcomes in stroke patients with atrial fibrillation on long-term oral anticoagulation. Neurology. 2023;100(17 Supplement):P11-5.030. doi:10.1212/WNL.0000000000204298
Kelly D, Rothwell P. Impact of multimorbidity on risk and outcome of stroke: lessons from chronic kidney disease. Int J Stroke. 2020;15(2):113-121. doi:10.1177/1747493020975250
Zheng M, Lavie CJ. Landscape of stroke comorbidities. Prog Cardiovasc Dis. 2024;84:12-20. doi:10.1016/j.pcad.2024.09.005
Qian Y, Chopp M, Chen J. Emerging role of microRNAs in ischemic stroke with comorbidities. Exp Neurol. 2020;331:113382. doi:10.1016/j.expneurol.2020.113382
Pande S, Morris J. Influence of chronic kidney disease and haemodialysis on stroke outcome. Singapore Med J. 2020;61(11):575-580. doi:10.11622/smedj.2020044
Branyan TE, Sohrabji F. Sex differences in stroke co-morbidities. Exp Neurol. 2020;332:113384. doi:10.1016/j.expneurol.2020.113384
Mohamed B, Yarlagadda K, Self ZB, Simon A, Rigueiro F, Sohooli M, et al. Obstructive sleep apnea and stroke: determining the mechanisms behind their association and treatment options. Transl Stroke Res. 2023;14(6):1125-1138. doi:10.1007/s12975-023-01123-x
Havenon AD, Ney J, Callaghan B, Delic A, Hohmann S, Shippey E, et al. Impact of COVID-19 on outcomes in ischemic stroke patients in the United States. J Stroke Cerebrovasc Dis. 2020;29(12):105535. doi:10.1016/j.jstrokecerebrovasdis.2020.105535
Qin C, Zhou LQ, Hu ZW, Yang S, Zhang S, Chen M, et al. Clinical characteristics and outcomes of COVID-19 patients with a history of stroke in Wuhan, China. Stroke. 2020;51(7):2219-2223. doi:10.1161/STROKEAHA.120.030365
Qureshi AI, Baskett WI, Huang W, Shyu D, Myers D, Raju M, et al. Acute ischemic stroke and COVID-19: an analysis of 27,676 patients. Stroke. 2021;52(3):905-912. doi:10.1161/STROKEAHA.120.031786
Siow I, Lee K, Zhang JJY, Saffari S, Ng A, Young B. Stroke as a neurological complication of COVID-19: a systematic review and meta-analysis of incidence, outcomes and predictors. J Stroke Cerebrovasc Dis. 2021;30(1):105549. doi:10.1
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 mahrukhsyed43@gmail.com
This work is licensed under a Creative Commons Attribution 4.0 International License.
Public Licensing Terms
This work is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Under this license:
- You are free to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material) for any purpose, including commercial use.
- Attribution must be given to the original author(s) and source in a manner that is reasonable and does not imply endorsement. If changes were made to the material, this must be indicated.
- No additional restrictions may be applied that conflict with the terms of this license.
For more details, visit: https://creativecommons.org/licenses/by/4.0/
