Survival and Predictors of Mortality Among Stroke Patients in Kinshasa (DRC): A Prospective Cohort Study

Abstract

Background: Stroke is a leading cause of mortality and severe disability in low- and middle-income countries. In the Democratic Republic of the Congo (DRC), longitudinal data and modeled survival estimates for in-hospital stroke patients remain extremely scarce.

Objective: To evaluate in-hospital survival and identify independent predictors of mortality among hospitalized stroke patients in the Gombe Health Zone, Kinshasa.

Methods: A prospective cohort study was conducted from August 2025 to June 2026 at the Renaissance University Hospital Center (CHUR) and Ngaliema University Hospital. A total of 250 consecutive patients with confirmed acute stroke were followed. Overall and cumulative survival rates were estimated using the Kaplan-Meier method (Log-Rank test). Independent predictors of mortality were identified via multivariate Cox proportional hazards regression analysis.

Results: The mean age of patients was 57.3 ± 13.3 years, with a marked male predominance (65.6%). Ischemic stroke accounted for 57.2% of cases and hemorrhagic stroke for 42.8%. Overall, in-hospital mortality reached 53.2% (n = 133), with a median overall survival time of 14.5 days (95% CI: 11.2 – 17.8). Survival was significantly worse in hemorrhagic strokes compared to ischemic strokes (median survival: 12.0 days vs. 29.0 days; Log-Rank p = 0.002). In multivariate Cox regression, initial neurological severity at admission (Glasgow Coma Scale < 8; aHR = 3.41 [95% CI: 2.15 – 5.41]; p < 0.001), hemorrhagic stroke subtype (aHR = 2.51 [95% CI: 1.62 – 3.89]; p = 0.001), early seizures (aHR = 2.67 [95% CI: 1.58 – 4.51]; p = 0.002), and severe secondary brain insults of systemic origin (SBISO / ACSOS; aHR = 3.16 [95% CI: 1.98 – 5.04]; p < 0.001) were major independent predictors of mortality.

Conclusion: In-hospital stroke mortality in the Gombe Health Zone is exceptionally high and occurs early. Aggressive and protocolized management of secondary systemic brain insults, strict blood pressure control, and the establishment of dedicated Stroke Units represent priority interventions to reduce this burden.

Keywords: Stroke, Survival, Cox Model, Kaplan-Meier, In-hospital Mortality, Secondary Brain Insults, Kinshasa.

Received Date: June 19, 2026

Accepted Date: July 10, 2026

Published Date: August 01, 2026

Available Online at: https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/863