Acute ischemic stroke in a university hospital intensive care unit: 1‐year costs and outcome

Abstract

Background and purpose: Little is currently known about the cost-effectiveness of intensive care of acute ischemic stroke (AIS). We evaluated 1-year costs and outcome for patients with AIS treated in the intensive care unit (ICU). Materials and methods:A single-center retrospective study of patients admitted to an academic ICU with AIS between 2003 and 2013. True healthcare expenditure was obtained up to 1 year after admission and adjusted to consumer price index of 2019.Patient outcome was 12-month functional outcome and mortality. We used multivariate logistic regression analysis to identify independent predictors of favorable outcomes and linear regression analysis to assess factors associated with costs. We calculated the effective cost per survivor (ECPS) and effective cost per favorable outcome (ECPFO). Results:The study population comprised 154 patients. Reasons for ICU admission were: decreased consciousness level (47%) and need for respiratory support (40%).There were 68 (44%) 1 year survivors, of which 27 (18%) had a favorable outcome.High age (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91-0.98) and high hospital admission National Institutes of Health Stroke Scale score (OR 0.92, 95% CI 0.87-0.97) were independent predictors of poor outcomes. Increased age had a cost ratio of 0.98 (95% CI 0.97-0.99) per added year. The ECPS and ECPFO were 115,628€ and 291,210€, respectively.Conclusions: Treatment of AIS in the ICU is resource-intense, and in an era predating mechanical thrombectomy the outcome is often poor, suggesting a need for further research into cost-efficacy of ICU care for AIS patients.

Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study

“…Approximately 80% of strokes are ischemic in nature, and nearly 15–20% of people admitted to stroke units require treatment in intensive care units (ICU) [ 2 , 3 ]. Worryingly, the long-term mortality rate in the ICU is a staggering 66%, while only 8–14% of patients have a favorable prognosis and survive [ 4 ]. In addition, ischemic stroke is associated with a wide range of complications, including dysphagia, dysarthria, aphasia, stroke-associated pneumonia, post-stroke depression and post-stroke delirium [ 1 , 5 ].…”

One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

“… 3 , 27 More cost studies using similar metrics for other diseases are needed in order to establish such threshold values. For example, the ECPIS of ICU-treated ICH patients (€184,940) is lower than that of ICU-treated patients with acute ischemic stroke (€291,210 34 ) but higher than that of ICU-treated patients with traumatic brain injury (€92,302 17 ) and subarachnoid hemorrhage (€96,360 3 ). However, ECPS and ECPIS do not account for indirect future costs, such as loss of ability to work.…”

Assessing the predictive value of neutrophil percentage to albumin ratio for ICU admission in ischemic stroke patients

“…Acute ischemic stroke (AIS) remains a substantial global health challenge, contributing to increased morbidity ( 1 , 2 ), disability ( 3 ), and mortality ( 4 , 5 ). While many cases of AIS can be efficiently treated in regular hospital environments or specialized stroke units, it is worth noting that approximately quarter of AIS patients require admission to an intensive care unit (ICU) ( 3 , 6 ).…”

“…These ICU admissions are crucial due to the severity of the condition. Importantly, the reported mortality rates for stroke patients receiving treatment in the ICU exhibit a wide range, varying from 14% to as high as 70% (1,(3)(4)(5), underscoring the need for comprehensive and targeted care strategies for this patient population.…”