EPIDEMIOLOGY AND HEALTH DATA INSIGHTS
Original Article
May 17, 2025 117 91

Predictors of All-cause Mortality among Stroke Patients in Kazakhstan: A Retrospective Study Using Integrated AI Data Extraction

Artem Yermakov 1 * ,
Kamila Akzholova 1 * ,
Temirgali Aimyshev 1,
Iliyar Arupzhanov 1,
Gulnur Zhakhina 1,
Abduzhappar Gaipov 1
1 Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan* Corresponding Author
Epidemiology and Health Data Insights, 1(1), 2025, ehdi003, https://doi.org/10.63946/ehdi/16386
Publication date: May 17, 2025
Full Text (PDF)

ABSTRACT

Aim: To examine all-cause mortality predictors among lab indicators and drugs administered to stroke patients in Kazakhstan.
Methods: This retrospective study analyzed data from 272 patient records derived from the UNEHS database (2014-2019). The GPT-4o model was used to dissect the records and assist in the extraction of lab and medication data; other clinical and demographic data were derived from the previous study [6]. Statistical analyses included univariate, multivariate, and imputed multivariate logistic regressions (STATA version 16.1).    
Results: In our cohort, deceased patients were older (66.1 vs. 58.6, p < 0.0001). Adjusted logistic regression revealed age (OR 1.04), hemoglobin (OR 0.97), and piracetam (OR 3.17) as independent predictors. After multiple imputation, Russian ethnicity (OR 2.79), PTI (OR 0.97), and dopamine (OR 5.23) became independent predictors, while piracetam lost its significance.
Conclusions: Findings suggest the importance of future research on stroke predictors in bigger cohorts to facilitate the introduction of innovations to stroke patients’ care to potentially decrease the burden on the Kazakhstani population.

KEYWORDS

Stroke Retrospective cohort study All-cause mortality Predictors of mortality AI-assisted data extraction Regression analysis

CITATION (Vancouver)

Yermakov A, Akzholova K, Aimyshev T, Arupzhanov I, Zhakhina G, Gaipov A. Predictors of All-cause Mortality among Stroke Patients in Kazakhstan: A Retrospective Study Using Integrated AI Data Extraction. Epidemiology and Health Data Insights. 2025;1(1):ehdi003. https://doi.org/10.63946/ehdi/16386
APA
Yermakov, A., Akzholova, K., Aimyshev, T., Arupzhanov, I., Zhakhina, G., & Gaipov, A. (2025). Predictors of All-cause Mortality among Stroke Patients in Kazakhstan: A Retrospective Study Using Integrated AI Data Extraction. Epidemiology and Health Data Insights, 1(1), ehdi003. https://doi.org/10.63946/ehdi/16386
Harvard
Yermakov, A., Akzholova, K., Aimyshev, T., Arupzhanov, I., Zhakhina, G., and Gaipov, A. (2025). Predictors of All-cause Mortality among Stroke Patients in Kazakhstan: A Retrospective Study Using Integrated AI Data Extraction. Epidemiology and Health Data Insights, 1(1), ehdi003. https://doi.org/10.63946/ehdi/16386
AMA
Yermakov A, Akzholova K, Aimyshev T, Arupzhanov I, Zhakhina G, Gaipov A. Predictors of All-cause Mortality among Stroke Patients in Kazakhstan: A Retrospective Study Using Integrated AI Data Extraction. Epidemiology and Health Data Insights. 2025;1(1), ehdi003. https://doi.org/10.63946/ehdi/16386
Chicago
Yermakov, Artem, Kamila Akzholova, Temirgali Aimyshev, Iliyar Arupzhanov, Gulnur Zhakhina, and Abduzhappar Gaipov. "Predictors of All-cause Mortality among Stroke Patients in Kazakhstan: A Retrospective Study Using Integrated AI Data Extraction". Epidemiology and Health Data Insights 2025 1 no. 1 (2025): ehdi003. https://doi.org/10.63946/ehdi/16386
MLA
Yermakov, Artem et al. "Predictors of All-cause Mortality among Stroke Patients in Kazakhstan: A Retrospective Study Using Integrated AI Data Extraction". Epidemiology and Health Data Insights, vol. 1, no. 1, 2025, ehdi003. https://doi.org/10.63946/ehdi/16386

SUPPLEMENTARY FILES

Supplementary materials

REFERENCES

  1. World Health Organization. The top 10 causes of death. 2024. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
  2. World Health Organization. Kazakhstan data. 2023. https://data.who.int/countries/398
  3. Sacco, R. L., Kasner, S. E., Broderick, J. P., Caplan, L. R., Connors, J. J. B., Culebras, A., Elkind, M. S. V., George, M. G., Hamdan, A. D., Higashida, R. T., Hoh, B. L., Janis, L. S., Kase, C. S., Kleindorfer, D. O., Lee, J.-M., Moseley, M. E., Peterson, E. D., Turan, T. N., Valderrama, A. L., & Vinters, H. V. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-2089. https://doi.org/10.1161/STR.0b013e318296aeca
  4. GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology. 2024;23(10):973-1003. https://doi.org/10.1016/s1474-4422(24)00369-7
  5. American Heart Association. 2025 Heart Disease & Stroke Statistical Update Fact Sheet Global Burden of Disease. American Heart Association. 2025. https://professional.heart.org/-/media/phd-files-2/science-news/2/2025-heart-and-stroke-stat-update/factsheets/2025-stats-update-fact-sheet-global-burden-of-disease.pdf
  6. Gulnur Zhakhina, Bakhytbek Zhalmagambetov, Arnur Gusmanov, Yesbolat Sakko, Sauran Yerdessov, Elzar Matmusaeva, Aliya Imanova, Crape, B., Sarria-Santamera, A., & Abduzhappar Gaipov. Incidence and mortality rates of strokes in Kazakhstan in 2014–2019. Scientific Reports. 2022;12(1). https://doi.org/10.1038/s41598-022-20302-8
  7. Nakibuuka, J., Sajatovic, M., Nankabirwa, J., Ssendikadiwa, C., Furlan, A. J., Katabira, E., Kayima, J., Kalema, N., Byakika-Tusiime, J., & Ddumba, E. Early mortality and functional outcome after acute stroke in Uganda: Prospective study with 30-day follow-up. SpringerPlus. 2015;4(450). https://doi.org/10.1186/s40064-015-1252-8
  8. Shah, B., Bartaula, B., Adhikari, J., Neupane, H. S., Shah, B. P., & Poudel, G. (2017). Predictors of in-hospital mortality of acute ischemic stroke in the adult population. Journal of Neurosciences in Rural Practice. 2017;8(4):591–594. https://doi.org/10.4103/jnrp.jnrp_265_17
  9. Schrock, J. W., Glasenapp, M., & Drogell, K. (2012). Elevated blood urea nitrogen/creatinine ratio is associated with poor outcome in patients with ischemic stroke. Clinical Neurology and Neurosurgery. 2012;114(7):881-884. https://doi.org/10.1016/j.clineuro.2012.01.031
  10. You, S., Zheng, D., Zhong, C., Wang, X., Tang, W., Sheng, L., Zheng, C., Cao, Y., & Liu, C.-F. Prognostic Significance of Blood Urea Nitrogen in Acute Ischemic Stroke. Official Journal of the Japanese Circulation Society. 2018;82(2):572-578. https://doi.org/10.1253/circj.CJ-17-0485
  11. Cohen, A. S., Siddiqui, K. A., Ali, S. F., Anderson, C. D., Silverman, S. B., & Schwamm, L. H. Abstract T P267: Admission Hemoglobin and Sodium Values are Important Factors Associated with Good Outcome After Acute Ischemic Stroke. Stroke. 2015;46(1). https://doi.org/10.1161/str.46.suppl_1.tp267
  12. Arnur Gusmanov, Gulnur Zhakhina, Sauran Yerdessov, Yesbolat Sakko, Kamilla Mussina, Aidar Alimbayev, Dmitriy Syssoyev, Sarría-Santamera, A., & Abduzhappar Gaipov. Review of the research databases on population-based Registries of Unified electronic Healthcare system of Kazakhstan (UNEHS): Possibilities and limitations for epidemiological research and Real-World Evidence. International Journal of Medical Informatics. 2022;170:104950–104950. https://doi.org/10.1016/j.ijmedinf.2022.104950
  13. National Kidney Foundation. Acute kidney injury (AKI). National Kidney Foundation. 2024. https://www.kidney.org/kidney-topics/acute-kidney-injury-aki
  14. Chen, C.-M., Hsu, H.-C., Chang, C.-H., Lin, C.-H., Chen, K.-H., Hsieh, W.-C., & Chang, W.-M. Age-based prediction of incidence of complications during inpatient stroke rehabilitation: a retrospective longitudinal cohort study. BMC Geriatrics. 2014;14(1). https://doi.org/10.1186/1471-2318-14-41
  15. Lab Tests Guide. Blood Urea VS BUN Definitions, Differences, and Similarities. Lab Tests Guide. 2023. https://www.labtestsguide.com/blood-urea-vs-bun
  16. Tsagalis, G., Akrivos, T., Alevizaki, M., Manios, E., Stamatellopoulos, K., Laggouranis, A., & Vemmos, K. N. (2008). Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality. Nephrology Dialysis Transplantation. 2008;24(1):194-200. https://doi.org/10.1093/ndt/gfn471
  17. Desai, A., Oh, D., Rao, E. M., Sahoo, S., Mahajan, U. V., Labak, C. M., Rohit Mauria, Shah, V. S., Nguyen, Q., Herring, E., Elder, T., Stout, A., & Shammassian, B. H. Impact of anemia on acute ischemic stroke outcomes: A systematic review of the literature. Impact of Anemia on Acute Ischemic Stroke Outcomes: A Systematic Review of the Literature. 2023;18(1):e0280025-e0280025. https://doi.org/10.1371/journal.pone.0280025
  18. Gill, D., Monori, G., Tzoulaki, I., & Dehghan, A. Iron Status and Risk of Stroke. Stroke. 2018;49(12):2815-2821. https://doi.org/10.1161/strokeaha.118.022701
  19. Kimberly, W. T., Wu, O., E. Murat Arsava, Garg, P., Ji, R., Vangel, M., Singhal, A. B., Ay, H., & Sorensen, A. G. Lower Hemoglobin Correlates with Larger Stroke Volumes in Acute Ischemic Stroke. Cerebrovascular Diseases Extra. 2011;1(1): 44–53. https://doi.org/10.1159/000328219
  20. Sosudinfo. Protrombin, protrombinovuy indeks I Vremya (PTI, PTV) – ponyatie, rol, normy i otkloneniya [in Russian]. 2024. https://sosudinfo.ru/krov/protrombin/#h2_5%20
  21. Morotti, A., & Goldstein, J. N. Anticoagulant-associated intracerebral hemorrhage. Brain Hemorrhages. 2020;1(1):89–94. https://doi.org/10.1016/j.hest.2020.01.001
  22. Sonne, J., & Lopez-Ojeda, W. Dopamine. StatPearls Publishing. 2025. https://www.ncbi.nlm.nih.gov/books/NBK535451/
  23. Hoh, B. L., Ko, N. U., Sepideh Amin-Hanjani, Sherry Hsiang-Yi Chou, Cruz-Flores, S., Dangayach, N. S., Derdeyn, C. P., Du, R., Hänggi, D., Hetts, S. W., Ifejika, N. L., Johnson, R., Keigher, K. M., Leslie-Mazwi, T. M., Lucke-Wold, B., Rabinstein, A. A., Robicsek, S. A., Stapleton, C. J., Suarez, J. I., & Tjoumakaris, S. I. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2023;54(7). https://doi.org/10.1161/str.0000000000000436
  24. Wheble, P. C. R., Sena, E. S., & Macleod, M. R. A Systematic Review and Meta-Analysis of the Efficacy of Piracetam and Piracetam-Like Compounds in Experimental Stroke. Cerebrovascular Diseases. 2007;25(1-2):5–11. https://doi.org/10.1159/000111493
  25. O’Donnell, M. J., Chin, S. L., Rangarajan, S., Xavier, D., Liu, L., Zhang, H., Rao-Melacini, P., Zhang, X., Pais, P., Agapay, S., Lopez-Jaramillo, P., Damasceno, A., Langhorne, P., McQueen, M. J., Rosengren, A., Dehghan, M., Hankey, G. J., Dans, A. L., Elsayed, A., & Avezum, A. (2016). Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388:761–775. https://doi.org/10.1016/S0140-6736(16)30506-2

LICENSE

Creative Commons License
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.