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Dynamic GCS Trajectories and Mortality Risk in ICU Patients with Stroke: A Multicenter, Age-Stratified Study
Juan Wang1,2,3, Wei Dai1,2,3, Man-Man Xu1,2,3
1Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, No. 321, Zhongshan Road, Gulou District, Nanjing City, Jiangsu Province, China.
Neurocritical Care
|July 20, 2026
Summary
Dynamic Glasgow Coma Scale (GCS) trajectories significantly predict mortality in non-traumatic stroke patients admitted to the ICU. Monitoring GCS changes over time improves risk stratification beyond baseline data.
Area of Science:
- Neurocritical care
- Neurology
- Intensive care medicine
Background:
- Non-traumatic stroke (NTS) is a leading cause of mortality and disability.
- Glasgow Coma Scale (GCS) is a key neurological assessment tool.
- Limited understanding of dynamic GCS changes in predicting outcomes for NTS patients.
Purpose of the Study:
- To investigate the association between GCS trajectories and mortality risk in ICU-admitted NTS patients.
- To assess if dynamic GCS data offers incremental prognostic value over baseline clinical variables.
Main Methods:
- Retrospective cohort study of 7876 patients from MIMIC-IV, eICU, and NSICU databases.
- Latent class growth modeling (LCGM) identified distinct GCS trajectories.
- Multivariable Cox regression analyzed associations between trajectories/metrics and in-hospital mortality.
Main Results:
- Four GCS trajectories identified: stable high, rapid improvement, persistent moderate, and persistent low.
- Mortality risk significantly increased across trajectories (HRs up to 17.72 for persistent low).
- Adding GCS trajectories improved predictive performance (AUC increased from 0.800 to 0.860).
Conclusions:
- Longitudinal GCS assessments (trajectory- and threshold-based) strongly correlate with in-hospital mortality in critically ill NTS patients.
- Dynamic GCS monitoring serves as a valuable complementary tool for risk stratification in neurocritical care.
- Identified a distinct gradual deterioration trajectory in elderly NTS patients (≥65 years).
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