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 the clinical severity, early complications, and short-term outcomes of acute stroke and to identify independent predictors of in-hospital mortality in a large prospective cohort from Guinea. Methods We conducted a hospital-based prospective cohort study including consecutive adult patients admitted for acute stroke to the Neurology Department of Ignace Deen National Hospital, Conakry, Guinea, between March 2021 and February 2024. Stroke diagnosis was confirmed by neuroimaging. Demographic, clinical, radiological, and outcome data were collected prospectively. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS). Multivariable logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results A total of 1,311 patients with confirmed stroke were included. Ischemic stroke accounted for 69.6% of cases, whereas intracerebral hemorrhage represented 27.0%. Only 5.3% of patients were admitted within 4 hours and 30 minutes after symptom onset, while 46.7% presented after more than 24 hours. Severe stroke (NIHSS ≥ 11) was observed in 62.2% of patients. Aspiration pneumonia was the most frequent in-hospital complication, affecting 20.4% of patients. Overall 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; p < 0.001), NIHSS ≥ 11 (aOR 3.91; 95% CI 2.45–6.12; p < 0.001), Glasgow score ≤ 12 (aOR 2.76; 95% CI 1.81–4.12; p < 0.001), intracerebral hemorrhage (aOR 2.21; 95% CI 1.42–3.42; p = 0.001), and age > 65 years (aOR 1.82; 95% CI 1.25–2.63; p = 0.002). Conclusions Acute stroke in Guinea is characterized by delayed hospital presentation, severe neurological impairment, frequent medical complications, and substantial in-hospital mortality. Aspiration pneumonia emerged as the strongest modifiable predictor of death. Strategies aimed at reducing prehospital delays, improving acute stroke care, and preventing post-stroke complications may substantially improve outcomes in resource-limited settings.