Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 26;10(12):911.
doi: 10.3390/brainsci10120911.

Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit-A Prospective Cohort Study

Fabio Pilato  1   2 , Serena Silva  3 , Iacopo Valente  4 , Marisa Distefano  1 , Aldobrando Broccolini  1   5 , Valerio Brunetti  1 , Pietro Caliandro  1 , Giacomo Della Marca  1   5 , Riccardo Di Iorio  1 , Giovanni Frisullo  1 , Mauro Monforte  1 , Roberta Morosetti  1 , Carla Piano  1 , Rosalinda Calandrelli  4 , Fioravante Capone  2 , Andrea Alexandre  4 , Alessandro Pedicelli  4 , Cesare Colosimo  4   5 , Anselmo Caricato  3   5
Affiliations

Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit-A Prospective Cohort Study

Fabio Pilato et al. Brain Sci. .

Abstract

Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20-11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04-10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61-0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92-0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11-0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65-37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency.

Keywords: acute ischemic stroke; neuro-intensive care unit; outcome; thrombectomy; thrombolysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patients’ enrollment.
Figure 2
Figure 2
Marginal effect of baseline NIHSS on the probability of a good outcome at 90 days (blue line) and 180 days (red line); the other covariates of the multivariable model are kept fixed. A good outcome is defined as eventual return to home or discharge to assisted living (modified Rankin scale (mRS) < 2).
Figure 3
Figure 3
Forest plot showing odds ratios of all clinical variable included in the predictive model for a 180-day good outcome.
Figure 4
Figure 4
Marginal effect of age on the probability of a good outcome at 180 days; the other covariates of the multivariable model are kept fixed. A good outcome is defined as eventual return to home or discharge to assisted living (mRS < 2).
See this image and copyright information in PMC

References

    1. GBD 2017 Causes of Death Collaborators Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–1788. doi: 10.1016/S0140-6736(18)32203-7. - DOI - PMC - PubMed
    1. Meschia J.F., Bushnell C., Boden-Albala B., Braun L.T., Bravata D.M., Chaturvedi S., Creager M.A., Eckel R.H., Elkind M.S.V., Fornage M., et al. Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroske Association. Stroke. 2014;45:3754–3832. doi: 10.1161/STR.0000000000000046. - DOI - PMC - PubMed
    1. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group Tissue plasminogen activator for acute ischemic stroke. N. Engl. J. Med. 1995;333:1581–1587. doi: 10.1056/NEJM199512143332401. - DOI - PubMed
    1. Hacke W., Kaste M., Bluhmki E., Brozman M., Dávalos A., Guidetti D., Larrue V., Lees K.R., Medeghri Z., Machnig T., et al. Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. N. Engl. J. Med. 2008;359:1317–1329. doi: 10.1056/NEJMoa0804656. - DOI - PubMed
    1. Berkhemer O.A., Fransen P.S.S., Beumer D., van den Berg L.A., Lingsma H.F., Yoo A.J., Schonewille W.J., Vos J.A., Nederkoorn P.J., Wermer M.J.H., et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N. Engl. J. Med. 2015;372:11–20. doi: 10.1056/NEJMoa1411587. - DOI - PubMed

LinkOut - more resources