Outcome Predictors of Acute Stroke Patients in Need of Intensive Care Treatment

Abstract

Background: The prognosis of stroke patients admitted to intensive care units (ICU) is commonly regarded to be poor. However, only limited data regarding outcome predictors are available. Patients and Methods: Out of 4,958 consecutive patients admitted to our stroke unit with the diagnosis of acute stroke, after analysis we identified 347 patients (164 male) in need of ICU management. In-hospital and post-rehabilitation mortality as well as functional outcome at discharge and after rehabilitation were analyzed. Results: Ischemic stroke was diagnosed in 252 patients (72.6%) and intracerebral hemorrhage occurred in 95 patients (27.4%). The mean age in our cohort was considerably high (70.8 years). One hundred patients were comatose at admission. The median NIHSS score at admission in the remaining patients was 12. Apart from stroke-related disturbances of consciousness (47.1%), the most common reasons for ICU treatment were cardiac (23.4%) and respiratory (12.1%) complications or interventional procedures requiring mechanical ventilation (11%). In all, 231/347 patients (66.6%) were mechanically ventilated (mean 84 h). In-hospital mortality (143/347; 41.2%) was associated with old age, poor NIHSS score at admission, intracerebral hemorrhage and mechanical ventilation (p < 0.001 in all). Further, admission to ICU because of stroke-related impairment of consciousness increased in-hospital mortality (p < 0.001). Similarly, poor outcome after rehabilitation was associated with old age (p = 0.029) and mechanical ventilation (p < 0.001). In patients ≥80 years with either intracerebral hemorrhage or need of mechanical ventilation, outcome was unfavorable in nearly any case. However, the overall post-rehabilitation outcome did not differ between patients with intracerebral hemorrhage and ischemic stroke (p = 0.275). Conclusion: The stroke population in our study was associated with an increased early mortality; however, given the same conditions, it was old with a high percentage of patients requiring mechanical ventilation. This did not result in increased in-hospital mortality rates compared to younger and less severely affected cohorts. Thus, ICU management is a life-saving initiative even among the elderly. However, the functional outcome was poor in older patients, thus limiting the benefits of ICU care in these patients.

Refining Prognosis for Intracerebral Hemorrhage by Early Reassessment

“…Prognostic models based on admission severity variables are important as risk adjustment techniques in clinical research and quality indices. [1–3] At the bedside, questions about prognosis arise as families and care teams seek to establish the appropriateness of interventions and clarify the goals of care. At the time those decisions are made, hours to days of additional information about the patient’s response to stabilization efforts are often available.…”

Neurocritical care for intracranial haemorrhage: a systematic review of recent studies

“…After screening for eligibility, 37 articles were excluded and 14 articles were selected ( Fig. 1) and categorized into the following four subcategories: risk stratification and NCC or ICU treatment, [13][14][15][16] haemodynamic management, 17-22 mechanical ventilation, 23 24 and pharmacological neuroprotection 25 26 (Table 2).…”

“…Recent literature provides insights on risk stratification of ICH in patients receiving non-vitamin K-antagonist anticoagulants [new oral anticoagulants (NOACs)] and in patients presenting with seizures, co-morbidity and complications associated with ICU treatment, and on limited benefit of ICU treatment in lowrisk patients presenting with post-traumatic ICH. [13][14][15][16] Clinical characteristics and the relationship with arterial blood pressure of ICH associated with chronic use of NOACs is reported in a retrospective cohort study in six patients (five receiving rivaroxaban and one apixaban). 13 In these patients, the mean time to onset was 146 ( 112) days after starting NOACs, and mean systolic arterial pressure (SAP; recorded 1 month before ICH) was 138 (16) mm Hg.…”

Real-world Effectiveness of Speech Therapy Time on Cognitive Recovery in Older Patients with Acute Stroke

“…Many patients with acute stroke also have disturbance of consciousness. 22) Rehabilitation provided by speech therapists for patients with consciousness disturbance often involves passive exercises involving the face and oral cavity. 53 (3.6) 0.995 FIM, Functional Independence Measure; GCS, Glasgow Coma Scale; HI-ST, high-intensity speech therapy; mRS, modified Rankin Scale.…”