Predictors of in-hospital case-fatality in patients with stroke at the National Hospital of the Kyrgyz Republic: a retrospective cohort study

BACKGROUND: Stroke-related mortality remains disproportionately high in Central Asia, with Kyrgyz Republic among the most affected countries. However, evidence on predictors of in-hospital death in this setting remains limited, particularly for comparative analyses of ischemic and hemorrhagic stroke. Identifying context-specific determinants of in-hospital death is essential for informing targeted strategies to improve acute stroke care and outcomes in resource-constrained health systems. METHODS: This retrospective cohort study included 1,259 patients with stroke (1,033 ischemic and 226 hemorrhagic) admitted in 2024 to the Neurology Department No. 2 of the National Hospital of the Kyrgyz Republic. Sociodemographic, lifestyle, medical and admission-related characteristics were extracted. Multivariable logistic regression was applied separately to ischemic and hemorrhagic stroke to identify independent predictors of in-hospital case-fatality. RESULTS: In-hospital case-fatality was 9.6% for ischemic and 21.7% for hemorrhagic stroke. In ischemic stroke, high Modified Early Warning Score (MEWS) (aOR = 75.1, 95% CI 29.18-193.21) and medium MEWS (aOR = 12.5, 95% CI 6.54-23.95) were strongest predictors of in-hospital case-fatality. Higher risk was noted among Bishkek residents (aOR = 4.2, 95% CI 1.72-9.94), those with prior myocardial infarction (aOR = 2.1, 95% CI 1.05-4.18) and ambulance admissions (aOR = 2.9, 95% CI 1.16-6.97). Overweight (aOR = 0.5, 95% CI 0.25-0.98) and hyperlipidemia (aOR = 0.5, 95% CI 0.26-0.84) were inversely associated with in-hospital case-fatality. In hemorrhagic stroke, high (aOR = 51.3, 95% CI 12.73-206.73) and medium (aOR = 7.5, 95% CI 2.23-25.40) MEWS, female sex (aOR = 2.8, 95% CI 1.09-7.36) and prior myocardial infarction (aOR = 5.94, 95% CI 1.45-24.29) increased case-fatality. CONCLUSION: This study provides early real-world, hospital-based evidence on predictors of in-hospital case-fatality among stroke patients in the Kyrgyz Republic. Early physiological risk stratification and targeted interventions for high-risk groups could improve outcomes and guide stroke care in low- and middle-income country settings.