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Published on: January 18, 2018
Outcomes of patients admitted to the ICU for acute stroke: a retrospective cohort
Thibaut Carval1, Charlotte Garret1, Benoît Guillon2
1Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093 Nantes Cedex 1, Nantes, France.
Insights
Outcomes for acute stroke patients in the intensive care unit (ICU) are poor, with less than 20% achieving good neurological recovery. Older age and lower Glasgow Coma Scale scores predict worse outcomes after ICU admission for stroke.
Area of Science:
- Neurology
- Critical Care Medicine
- Public Health
Background:
- Acute stroke is a major global cause of death and disability.
- Limited data exist on the long-term outcomes of stroke patients admitted to the intensive care unit (ICU).
- Understanding factors influencing neurological recovery is crucial for improving patient care.
Purpose of the Study:
- To identify factors associated with good neurological outcomes (modified Rankin Scale score 0-2) at 6 months post-ICU admission for acute stroke.
- To analyze predictors of functional recovery in a cohort of critically ill stroke patients.
Main Methods:
- Retrospective study of 323 acute stroke patients admitted to a French university hospital ICU (2014-2018).
- Exclusion of patients with isolated subarachnoid hemorrhage or posttraumatic stroke.
- Multivariable analysis to determine factors independently associated with neurological outcome at 6 months.
Main Results:
- A total of 323 patients (median age 67 years, 53.6% male) were included.
- The majority of strokes were hemorrhagic (76.8%). Mechanical ventilation was required in 79.6% of patients.
- Only 19.5% of patients achieved a good neurological outcome (mRS 0-2) at 6 months; 64.5% died.
Conclusions:
- Acute stroke requiring ICU admission is associated with a high mortality rate and poor functional outcomes.
- Older age and lower Glasgow Coma Scale scores at ICU admission are independent predictors of poor neurological outcome.
- Targeted interventions for elderly stroke patients with low GCS scores may improve outcomes.
Background:
Although acute stroke is a leading cause of morbidity and mortality worldwide, data on outcomes of stroke patients requiring ICU admission are limited. We aimed to identify factors associated with a good neurological outcome (defined as a modified Rankin Scale score [mRS] of 0-2) 6 months after ICU admission.
Methods:
We retrospectively studied consecutive patients who were admitted to the ICU of a French university-affiliated hospital between January 2014 and December 2018 and whose ICD-10 code indicated acute stroke. Patients with isolated subarachnoid hemorrhage or posttraumatic stroke were excluded.
Results:
The 323 identified patients had a median age of 67 [54.5-77] years; 173 (53.6%) were male. The main reasons for ICU admission were neurological failure (87%), hemodynamic instability (28.2%), acute respiratory failure (26%), and cardiac arrest (5.3%). At ICU admission, the Glasgow Coma Scale score was 6 [4-10] and the SAPSII was 54 [35-64]. The stroke was hemorrhagic in 248 (76.8%) patients and ischemic in 75 (23.2%). Mechanical ventilation was required in 257 patients (79.6%). Six months after ICU admission, 61 (19.5%) patients had a good neurological outcome (mRS, 0-2), 50 (16%) had significant disability (mRS, 3-5), and 202 (64.5%) had died; 10 were lost to follow-up. By multivariable analysis, factors independently associated with not having an mRS of 0-2 at 6 months were older age (odds ratio, 0.93/year; 95% confidence interval, 0.89-0.96; P < 0.01) and lower Glasgow Coma Scale score at ICU admission (odds ratio, 1.23/point; 95% confidence interval, 1.07-1.40; P < 0.01).
Conclusions:
Acute stroke requiring ICU admission carried a poor prognosis, with less than a fifth of patients having a good neurological outcome at 6 months. Age and depth of coma independently predicted the outcome.
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