Predictors of functional outcome at 1 year after stroke: analysis of INTERSTROKE data from Pakistan

Background and Objective

Identification of early and long-term outcomes after stroke is important in stroke management strategies. The aim of this study was to analyse predictors of independence and functional outcome at 1 and 12 months post-stroke. Methods This was a prospective study of patients with first stroke who were enrolled between April 2013 and July 2015 from a single-centre tertiary care hospital in Pakistan. Patients were followed up at 1 and 12 months and assessed using the modified Rankin scale (mRs).

Results

A total of 395 patients with acute first strokes were enrolled. Stroke dependency (mRs score 3-5) was higher in our site at 1 month. At 1 month, 137 (34.6%) of the participants were independent (mRs 0-2), 54.1% (n = 214) were dependent (mRs 3-5) and 11.1% (n = 44) died. At 12 months, 86% (n = 303/351) completed the follow-up. Of 303 participants, 35.3% (n = 107) were independent (mRs 0-2), 35.6% (n = 108) were dependent (mRs 3-5) and 29% (n = 88) had died. Forty-eight patients (14%) were lost to follow-up. Overall mortality was 33% (132/395) in 1 year. At 12 months, no comorbidities (OR 3.26; 95% CI: 1.48-7.21) and normal level of consciousness at onset (OR 3.44; 95% CI: 1.93-6.12) were associated with greater post-stroke independence (mRs 0-2). Out of 395, 111 (28.1%) patients with no or minimal disability at 1 month (mRs 0-2), 32.4% showed worsening of disability (mRs 3-5) at 12 months.

Conclusion

At 1 year, 33% died and 36% were dependent. A large number (60%) of patients with minimal disability at 30 days worsened or died at 1 year.