Prevalence of Mortality and Morbidity in Ischemic versus Hemorrhagic Strokes using mSOAR Score

Abstract

Background: Stroke is the second most common cause of mortality worldwide and it pose a significant threat to the population of low- and middle-income countries, including Pakistan. This study aims at determining the prevalence of Mortality and Morbidity in Ischemic versus Hemorrhagic Strokes using mSOAR Score presenting to a tertiary care hospital, Karachi Pakistan.

Methods: This comparative observational study was conducted from 20 March 2024 to 20 September 2024.  After taking ethical approval from clinical research committee (CRC) and the ethical review committee (ERC) Ziauddin University Hospital Karachi (REF# 8470224RYNEU) The patients of either gender aged 18years and above presenting with stroke visiting the “Department of Neurology” Ziauddin hospital North Nazimabad were recruited by using non-probability consecutive sampling. An informed consent was taken from patients prior to data collection. The calculated “sample size” was found to be 248(124 in each group) by using Lin naing calculator. The data was collected by using a questionnaire. All the patients who are presented with stroke symptoms in emergency department had neuro-imaging either CT scan or MRI brain and this would be basic protocol of stroke patients. The findings of CT scan and MRI brain assessed stroke type (hemorrhagic or ischemic), size and site of stroke. Regarding clinical scores, mSOAR score was calculated. It is composed of the designated scores for each of the following 5 domains: stroke subtype, OCSP project classifications, age, mRS and NIHSS. The score of mSOAR is calculated by combining the score of the 5 domains. The “researcher” followed the patient during hospital stays and after discharge. The mortality and morbidity (mSOAR ≥4) of the patients were noted during hospital stay as well as after discharge. The patients were contacted by the researcher through telephonic contact from their index stroke from discharge till 3 months follow up to label mortality and morbidity (mSOAR ≥4). The data was analyzed by using SPSS version 22. The “Quantitative variables” age, GCS were presented in “mean” and “standard deviation. Percentages and frequencies were calculated for qualitative variables like gender, type of stroke, mortality and morbidity. The data was non parametric therefore Mann Whitney U test was used to find statistically significant difference between groups. p≤0.05 was taken as significant.

Result: The mean age of study subjects were 62.04±12.84. Group A (ischemic) has higher scores across all components of the GCS compared to Group B (hemorrhagic), suggesting better levels of consciousness in the ischemic group. Group A, more patients had lower mSOAR scores (≤4) (70 vs. 54) and (110 vs. 7), suggesting a potentially better prognosis during their hospital stay and three month follow up respectively. In Group B more patients had higher mSOAR scores (≥4) (95 vs. 29) at hospital stay and (70 vs. 26) at three months follow up; Hence group A showed better prognosis. There was statistically

a significant difference between groups at hospital stay and three months follow up(p=0.00 each). For mortality among Group A (Ischemic) 7 out of 124 patients (5.6%) died, in Group B (Hemorrhagic) 28 out of 124 patients (22.6%) died and overall mortality (combined groups) was found to be 35 out of 248 patients (14.1%). Regarding hospital stay morbidity, 75 out of 124 patients (60.5%) in Group A (ischemic) experienced morbidity whereas in Group B (Hemorrhagic) 112 out of 124 patients (90.3%) had morbidity during hospitalization. 17 out of 124 patients (13.7%) in Group A (Ischemic) experienced morbidity at the 3-month follow-up, 38 out of 124 patients (30.6%) in Group B (Hemorrhagic) experienced morbidity at the 3-month follow-up.

Conclusion: This study concluded that the prevalence of mortality and morbidity was more among group B (Hemorrhagic) as compared to group A(Ischemic). Hence group A had better prognosis.