Clinical severity, early complications and in-hospital mortality after acute stroke: a prospective cohort of 1,311 patients from Guinea

Abstract Background Stroke is a leading cause of death and disability worldwide, with a disproportionate burden in low- and middle-income countries. Data describing stroke severity, early complications, and short-term outcomes in sub-Saharan Africa remain limited. This study aimed to evaluate clinical severity, early complications, and short-term outcomes and to identify independent predictors of in-hospital mortality among adults admitted with imaging-confirmed acute stroke in Guinea. Methods We conducted a hospital-based prospective cohort study of consecutive adults admitted to the Neurology Department of Ignace Deen National Hospital, Conakry, between March 2021 and February 2024. Stroke was defined using contemporary tissue-based criteria and confirmed by CT or MRI. Demographic, clinical, radiological, treatment, and outcome data were collected prospectively. Stroke severity was assessed using the NIHSS and GCS. Multivariable logistic regression identified independent predictors of in-hospital mortality. Results Among 1,657 screened patients, 1,311 with imaging-confirmed stroke were included. Ischemic stroke accounted for 69.6% and intracerebral hemorrhage for 27.0%. Only 5.3% arrived within 4.5 h, whereas 46.8% arrived after more than 24 h. NIHSS ≥ 11 was observed in 62.2%, aspiration pneumonia occurred in 20.4%, and in-hospital mortality was 19.6%. Independent predictors of mortality were aspiration pneumonia (adjusted odds ratio [aOR] 4.15; 95% confidence interval [CI] 2.76–6.21), NIHSS ≥ 11 (aOR 3.91; 95% CI 2.45–6.12), GCS ≤ 12 (aOR 2.76; 95% CI 1.81–4.12), hemorrhagic stroke (aOR 2.21; 95% CI 1.42–3.42), and age > 65 years (aOR 1.82; 95% CI 1.25–2.63). Conclusions Imaging-confirmed acute stroke treated at this tertiary hospital was characterized by delayed presentation, severe neurological impairment, frequent complications, and substantial in-hospital mortality. Aspiration pneumonia was the strongest potentially modifiable predictor of death. Improving timely access, organized acute stroke care, and prevention of post-stroke complications may improve hospital outcomes in comparable resource-constrained referral settings.