Outcomes of patients admitted to the ICU for acute stroke: a retrospective cohort

Abstract

Background: Although acute stroke is a leading cause of morbidity and mortality worldwide, data on outcomes of stroke patients requiring ICU admission are limited. We aimed to identify factors associated with a good neurological outcome (defined as a modified Rankin Scale score [mRS] of 0-2) 6 months after ICU admission.

Methods: We retrospectively studied consecutive patients who were admitted to the ICU of a French university-affiliated hospital between January 2014 and December 2018 and whose ICD-10 code indicated acute stroke. Patients with isolated subarachnoid hemorrhage or posttraumatic stroke were excluded.

Results: The 323 identified patients had a median age of 67 [54.5-77] years; 173 (53.6%) were male. The main reasons for ICU admission were neurological failure (87%), hemodynamic instability (28.2%), acute respiratory failure (26%), and cardiac arrest (5.3%). At ICU admission, the Glasgow Coma Scale score was 6 [4-10] and the SAPSII was 54 [35-64]. The stroke was hemorrhagic in 248 (76.8%) patients and ischemic in 75 (23.2%). Mechanical ventilation was required in 257 patients (79.6%). Six months after ICU admission, 61 (19.5%) patients had a good neurological outcome (mRS, 0-2), 50 (16%) had significant disability (mRS, 3-5), and 202 (64.5%) had died; 10 were lost to follow-up. By multivariable analysis, factors independently associated with not having an mRS of 0-2 at 6 months were older age (odds ratio, 0.93/year; 95% confidence interval, 0.89-0.96; P < 0.01) and lower Glasgow Coma Scale score at ICU admission (odds ratio, 1.23/point; 95% confidence interval, 1.07-1.40; P < 0.01).

Conclusions: Acute stroke requiring ICU admission carried a poor prognosis, with less than a fifth of patients having a good neurological outcome at 6 months. Age and depth of coma independently predicted the outcome.

Keywords: Coma; Disability; Intensive care unit; Mechanical ventilation; Stroke.

Fig. 1

Study flowchart. ICU, intensive care unit; mRS, modified Rankin Scale; SAH, subarachnoid hemorrhage; SDH: subdural hemorrhage

Fig. 2

Neurological outcome assessed using the modified Rankin Scale score (mRS) 28 days and 6 months after ICU admission. Missing data: n = 26 (8%) on day 28 and n = 10 (3.1%) at month 6

Fig. 3

Proportion of patients with a favorable neurological outcome at month 6 according to age and Glasgow Coma Scale score. Favorable neurological outcome was defined as a modified Rankin Scale (mRS) score of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability). mRS, modified Rankin Scale score; SAH: subarachnoid hemorrhage; SDH: subdural hematoma; ICU: intensive care unit