Comparative Analysis of Clinical and Metabolic Profiles in Ischemic Versus Hemorrhagic Stroke Among Adults Presenting to a Tertiary Care Hospital.

AIM AND BACKGROUND: Stroke remains a major cause of mortality and morbidity, with substantial heterogeneity in risk factors and outcomes by subtype. This study aimed to compare the prevalence and clinical profiles of ischemic and hemorrhagic strokes and to evaluate the distribution of demographic, neurological, clinical, and metabolic variables among adults presenting within 24 hours of symptom onset. MATERIALS AND METHODS: A cross-sectional observational study was conducted at a tertiary care hospital in Lahore from June 2023 to July 2024. A total of 800 adults diagnosed with ischemic or hemorrhagic stroke were enrolled using non-probability consecutive sampling. Demographic, clinical, and laboratory parameters, including body mass index (BMI), Glasgow Coma Scale (GCS), blood pressure, lipid profile, glycated hemoglobin (HbA1c), and renal function, were recorded within 24 hours of admission.  Results: In this study of 800 patients, ischemic stroke was identified in 565 (70.6%) and hemorrhagic stroke in 235 (29.4%). Patients aged 50 years or younger had significantly lower odds of ischemic stroke compared to those above 50 years (OR = 0.515, p < 0.001). No significant association was observed between gender and stroke type. High socioeconomic status was associated with a greater proportion of hemorrhagic stroke (χ² = 19.69, p < 0.001). Ever smokers had higher odds of ischemic stroke (OR = 1.405, 95% CI: 1.027-1.921, p = 0.033). Hypertension (HTN) was significantly more frequent in hemorrhagic stroke (OR = 1.453, 95% CI: 1.055-2.000, p = 0.022), while diabetes mellitus (DM) and dyslipidemia showed no significant association with stroke type. Chronic kidney disease was not significantly associated with hemorrhagic stroke (OR = 1.678, 95% CI: 0.996-2.826, p = 0.050). Presentation within 4.5 hours of symptom onset was significantly associated with hemorrhagic stroke (OR = 2.993, 95% CI: 2.034-4.405, p < 0.001). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher in hemorrhagic stroke (SBP mean difference (MD) = -31.30, 95% CI: -36.02 to -26.58, p < 0.001; DBP MD = -10.01, 95% CI: -14.74 to -5.28, p < 0.001). Ischemic stroke patients had higher total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglycerides, while hemorrhagic stroke patients had higher high-density lipoprotein cholesterol (HDL-C) and blood urea. In-hospital mortality occurred in 74 (13.1%) of the ischemic stroke group and 57 (24.3%) of the hemorrhagic stroke group, with significantly higher mortality associated with hemorrhagic stroke (OR = 2.17, 95% CI: 1.47-3.20, p < 0.001). Mortality was also associated with advanced age, lower Glasgow Coma Scale score, higher systolic blood pressure, and elevated cholesterol and triglyceride levels. CONCLUSION: This study highlights distinct demographic, clinical, and metabolic profiles between ischemic and hemorrhagic stroke. Hypertension, high socioeconomic status, and early hospital presentation were associated with hemorrhagic stroke, while ischemic stroke was more prevalent among older patients and smokers. In-hospital mortality was significantly higher in hemorrhagic stroke and was linked to advanced age, reduced Glasgow Coma Scale score, and adverse metabolic parameters.