A total of 129 patients hospitalized for stroke during the study period were included in the analysis. Men accounted for 55.8% (n = 72) of the study population, yielding a male-to-female ratio of 1.26. The mean age was 59.8 years (95% CI: 57.5 - 62.2), with most patients aged over 60 years.

Most patients resided in Bangui (67.4%), while 32.6% were referred from other provinces. No significant association was found between mortality and age group (p = 0.30), sex (p = 0.80), educational level (p = 0.30), marital status (p = 0.40), occupation (p = 0.60), or place of residence (p = 0.20). See Table 1.

The median delay between symptom onset and hospital admission was 7 days (interquartile range: 5 - 9 days). The most frequent presenting symptoms were headache (62%), sudden-onset motor deficit involving one side of the body (58.1%), language impairment (41%), altered consciousness, and dizziness. Hypertension was the most common vascular risk factor, followed by diabetes mellitus and a family history of stroke. Ischemic stroke was the predominant subtype, accounting for 60.2% of cases.

Table 1.Association between sociodemographic characteristics and patient outcome.

In-Hospital Mortality

Among the 129 patients included in the study, 15 died during hospitalization, resulting in an overall in-hospital mortality rate of 12%. See Table 2.

Hospital Complications Associated with Mortality

Several in-hospital complications were significantly associated with mortality.

Dysphagia was observed in 53 patients and was significantly associated with death (p = 0.03). Neurological deterioration occurred in 41 patients and showed a strong association with mortality (p < 0.001). Cardiac complications were also significantly associated with death (p = 0.003). Likewise, pulmonary complications were more frequent among non-survivors and were significantly associated with mortality (p < 0.001).

No significant association was observed between urinary tract infection and mortality (p = 0.50).

Table 2.Association between in-hospital complications and patient outcome.

Multivariable logistic regression analysis was performed to identify independent predictors of in-hospital mortality. The final model demonstrated excellent discriminative ability, with an area under the receiver operating characteristic (ROC) curve of 0.972. After adjustment for potential confounding factors, three variables remained independently associated with mortality:

Hyperthermia (body temperature ≥ 38˚C) was associated with a markedly increased risk of death (adjusted OR = 90.44; 95% CI: 1.02 - 7986.28; p = 0.049);Language impairment was a strong independent predictor of mortality (adjusted OR = 125.53; 95% CI: 2.67 - 5907.38; p = 0.014);Neurological deterioration during hospitalization was the strongest predictor of death (adjusted OR = 178.86; 95% CI: 1.73 - 18499.55; p = 0.028).

Two additional variables showed borderline statistical significance:

Admission more than 24 hours after symptom onset (adjusted OR = 40.38; 95% CI: 0.98 - 1661.99; p = 0.051);Family history of stroke (adjusted OR = 22.99; 95% CI: 0.91 - 581.44; p = 0.057).

No significant associations were observed for age, sex, level of consciousness, seizure occurrence, stroke subtype, dysphagia, cardiac complications, or pulmonary infection after adjustment in the multivariable model. Overall, delayed hospital admission, hyperthermia, language impairment, and neurological deterioration appeared to be the major determinants of mortality among stroke patients in this cohort.

This study has several limitations that should be acknowledged. First, its retrospective design exposed the analysis to missing data and potential information bias. Second, several medical records were incomplete or unavailable, which may have led to an underestimation of the actual number of stroke cases. Third, some potentially relevant clinical, radiological, and biological variables were not systematically documented and therefore could not be included in the analysis. Finally, this was a single-center study conducted in the national referral neurology department, which may limit the generalizability of the findings to the entire population of the Central African Republic. Despite these limitations, the study provides valuable insights into factors associated with stroke mortality in a resource-limited setting.

Age andSex:The mean age of patients in our study was 59.8 years. This finding is consistent with reports from Burkina Faso, Madagascar, and the Republic of Congo, where mean ages of 59.07, 60.53, and 62.70 years, respectively, have been reported [10]-[12]. In contrast, studies conducted in Europe reported substantially older populations, with mean ages of 73 years in France [13], 72.4 years in Geneva [14], and 71.9 years in Spain [15]. This younger age at stroke onset in African populations may be explained by the earlier exposure to modifiable vascular risk factors and lower life expectancy compared with high-income countries. Similarly, a comparative study demonstrated that stroke occurs approximately ten years earlier among Africans than among African Americans and European Americans [16].

A male predominance was observed in our cohort, with a sex ratio of 1.2. This finding is in agreement with several African studies reporting male predominance [17]-[19], although female predominance has also been described in Burkina Faso [10] and Côte d’Ivoire [20]. Such discrepancies may reflect differences in study populations, healthcare access, and sociocultural factors. Neither age (p = 0.30) nor sex (p = 0.80) was significantly associated with mortality in our study. Similar findings have been reported elsewhere. However, several studies have identified advanced age as a major predictor of stroke mortality, particularly among patients aged 60 years and older [21][22]. The increased mortality observed among elderly patients is often attributed to the higher prevalence of comorbid conditions such as heart failure, atrial fibrillation, chronic kidney disease, and frailty.

Vascular Risk Factors:Hypertension (86.4%) and diabetes mellitus (38%) were the most prevalent vascular risk factors in our cohort. Hypertension remains the most important modifiable risk factor for stroke worldwide and has been consistently reported across African studies [23]-[25] as well as in high-income countries [26]. Although mortality appeared slightly higher among patients with hypertension, diabetes, or a history of previous stroke, these differences did not reach statistical significance. In contrast, Mananjo et al. reported hypertension (p = 0.01), smoking (p = 0.01), and previous stroke (p = 0.009) as significant predictors of acute stroke mortality [27]. The absence of a significant association in our study may be related to the relatively small sample size and limited statistical power.

In-Hospital Mortality:The overall in-hospital mortality rate was 12%, which is comparable to rates reported in Gabon (9.5%) [28] and Burkina Faso (12.5%) [29]. However, higher mortality rates have been documented in several African studies [9][30]-[32]. These differences may be explained by variations in study design, patient characteristics, follow-up duration, and healthcare resources. In contrast, mortality rates reported in developed countries are substantially lower, ranging from 3.3% in Denmark to approximately 8% in Canada and the Netherlands [33]-[35].

The lower mortality observed in high-income countries is largely attributable to early admission to specialized stroke units, rapid neuroimaging, thrombolytic therapy, and comprehensive multidisciplinary care. In many African countries, including the Central African Republic, the absence of stroke units, delayed access to neuroimaging, and limited availability of reperfusion therapies continue to negatively affect patient outcomes.

Delay in Hospital Admission:In our study, nearly one-third of patients were admitted more than 24 hours after symptom onset. Delayed admission showed a strong trend toward association with mortality in multivariable analysis. Several factors may explain this delay, including poor recognition of stroke warning signs, initial recourse to traditional medicine, financial constraints, and delayed referral to specialized healthcare facilities. Similar findings have been reported in the Central African Republic by Mbellesso et al. [36] and in Senegal [37]. Delayed hospital presentation remains a major challenge in low-resource settings and significantly reduces opportunities for timely intervention and optimal management.

Altered Consciousness and Neurological Severity:Although no patient presented with a Glasgow Coma Scale score below 8, altered consciousness at admission was associated with increased mortality risk. Altered consciousness is widely recognized as a marker of severe brain injury and poor neurological status. Our findings are consistent with previous studies conducted in Africa [38][39] and in developed countries [40]-[42], where impaired consciousness was associated with poor functional outcomes and increased mortality. Early identification of patients with severe neurological impairment is therefore essential for optimizing monitoring and supportive care.

Hyperthermia:Hyperthermia emerged as an independent predictor of mortality in our study. Similar observations have been reported by Mananjo et al. [27] and by Roy et al. in India [43]. Several mechanisms may explain this association. Fever increases cerebral metabolic demand and oxygen consumption in already compromised brain tissue, thereby exacerbating ischemic injury and promoting cerebral edema and hemorrhagic transformation [44]. Furthermore, hyperthermia may reflect underlying infectious complications, which themselves contribute to poor outcomes. Because fever represents a potentially modifiable factor, early identification and aggressive management of hyperthermia should be considered an integral component of acute stroke care.

HospitalComplications:Dysphagia was common in our cohort and was significantly associated with mortality. Dysphagia increases the risk of aspiration pneumonia, which is a major determinant of poor outcomes after stroke. Smithard etal. demonstrated a significant relationship between swallowing disorders and pulmonary infections during the first week following cerebral infarction [45]. Likewise, Hilker et al. reported that aspiration pneumonia increased mortality threefold among stroke patients [46]. Previous studies have also shown that pneumonia accounts for nearly one-quarter of deaths occurring within the first month after stroke [47]. In addition to dysphagia, neurological deterioration, cardiac complications, and pulmonary diseases were strongly associated with mortality. These findings highlight the importance of early detection and management of in-hospital complications to improve survival outcomes among stroke patients. See Table 3.

Table 3.Independent factors associated with mortality: results of the final multivariable logistic regression model.

aOR: Adjusted Odds Ratio; CI: Confidence Interval; p-value: Level of significance.