Risk Factors for Mortality in Stroke Patients Admitted to Critical Care Units: A Systematic Review and Meta-Analysis

Stroke is a leading cause of morbidity and mortality worldwide, and patients admitted to intensive care units (ICUs) who require mechanical ventilation face an even higher risk of adverse outcomes, including increased mortality. Effective management in ICUs is crucial to improve patient outcomes.

This systematic review and meta-analysis aimed to synthesize existing evidence on the risk factors associated with mortality in stroke patients admitted to any form of critical care units.

A comprehensive search was conducted across four databases: PubMed, Web of Science, Scopus, and Embase, up to July 9, 2024. Studies were included if they evaluated mortality risk factors in adult stroke patients admitted to critical care units. Data were extracted and analyzed using a random-effects model to account for heterogeneity. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for various risk factors.

Eighteen studies involving 20,442 patients were included in the meta-analysis. Age was significantly associated with increased mortality (OR = 1.02; 95% CI: 1.01, 1.04). Lower Glasgow coma scale (GCS) scores were linked to higher mortality (OR = 0.93; 95% CI: 0.86, 1.01), though not statistically significant (P = 0.08). Higher National Institutes of Health Stroke Scale (NIHSS) scores showed a significant association with increased mortality (OR = 1.06; 95% CI: 1.03, 1.09), (p < 0.0001). Mechanical ventilation and higher body temperature (≥37.5°C) were associated with a higher risk of death (OR = 1.9; 95% CI: 1.65, 2.18) and (OR = 2.03; 95% CI: 1.56, 2.66) respectively. Atrial fibrillation (OR = 1.19; 95% CI: 1.06, 1.34) significantly contributed to mortality risk, while a higher body mass index (BMI) was not associated with a reduced risk of mortality (OR = 0.97; 95% CI: 0.92, 1.02).

This study highlights the critical importance of early identification and targeted management of high-risk stroke patients in critical care settings. Age, neurological status, respiratory support needs, and specific comorbidities are key factors that clinicians should consider improving survival outcomes. Further research is needed to refine these findings and optimize care strategies for critically ill stroke patients.