Risk Factors for Mortality in the Acute Phase of Hemorrhagic Stroke at Befelatanana University Hospital, Antananarivo, Madagascar

Background: Hemorrhagic stroke is characterized by the sudden onset of a neurological deficit of presumed vascular origin, resulting from blood extravasation into the cerebral parenchyma. This study aimed to identify clinical and paraclinical risk factors associated with mortality during the acute phase of hemorrhagic stroke at Befelatanana University Hospital. Methods: We conducted a retrospective case-control study, over a 30-month period. All hospitalized patients diagnosed with hemorrhagic stroke confirmed by neuroimaging were included. Cases were defined as patients who died within the first 7 days of admission due to neurological causes; controls were patients discharged alive from the neurology department. Independent predictors of mortality were subsequently identified using multivariate binary logistic regression. Results: A total of 313 patients were included, with a slight male predominance (50.8%) and a mean age of 55.5 ± 11.3 years. Factors significantly associated with mortality on bivariate analysis included: mean arterial pressure ≥ 130 mmHg (p < 0.0001), hyperthermia ≥ 38？C (p < 0.0001), hyperglycemia ≥ 2 g/L (OR, 17.35; p < 0.001), Glasgow Coma Scale (GCS) score ≤ 13 (OR, 39.94 for 8 - 13, and non-estimable for ≤8), National Institutes of Health Stroke Scale (NIHSS) score ≥ 15 (OR, 32.66), modified Rankin Scale (mRS) score ≥ 3 (p < 0.0001), clinical and radiologic signs of cerebral herniation (OR, 97.52 and 19.47, respectively), infratentorial hematoma (p = 0.044), Intracerebral Hemorrhage (ICH) score between 3 and 5 (OR, 112.21), acute hydrocephalus (OR, 41.51), and neurosurgical intervention performed for severe presentations (OR, 110). On multivariate binary logistic regression only four variables remained independently associated with in-hospital mortality: GCS < 14 (adjusted OR, 35.47), clinical signs of cerebral herniation (adjusted OR, 20.43), acute hydrocephalus (adjusted OR, 9.69), and mean arterial pressure ≥ 130 mmHg (adjusted OR, 3.53). Conclusions: Identification of these risk factors may improve early management strategies during the acute phase of stroke. Multivariate analysis confirms altered consciousness, cerebral herniation, hydrocephalus, and elevated mean arterial pressure as independent early predictors, which should guide risk stratification and clinical decision-making from admission.