Impact of intensive care-related factors on outcome in stroke patients, results from the population-based Brest Stroke Registry: an observational study.

Abstract

Background Little is known on the burden of ICU care for stroke patients. The aim of this study was to provide a description of management strategies, resource use, complications and their association with prognosis of stroke patients admitted to ICU. Methods Using a population-based stroke registry, we analyzed consecutive stroke patients admitted to 3 ICU with at least one organ failure between 2008 and 2017. The study period was divided into two periods corresponding to the arrival of mechanical reperfusion technique. Predictors of ICU mortality were separately assessed in two multivariable logistic regression models, a “clinical model” and an “intervention model”. The same analysis was performed for predictors of functional status at hospital discharge. Results 215 patients were included. Stroke etiology was ischemia in 109 patients (50.7%) and hemorrhage in 106 patients (49.3%). Median NIHSS score was 20.0 (9.0; 40.0). The most common reason for ICU admission was coma (41.2%) followed by acute circulatory failure (41%) and respiratory failure (27.4%). 112 patients (52%) died in the ICU and 20 patients (11.2%) had a good functional outcome (mRS≤3) at hospital discharge. In the "clinical model,” factors independently associated with ICU mortality were: age (OR = 1.03 [95%CI, 1.0 to 1.06]; p=0.04) and intracranial hypertension (OR = 6.89 [95%CI, 3.55 to 13.38]; p<0.0001). In the “intervention model,” the need for invasive mechanical ventilation (OR = 7.39 [95%CI, 1.93 to 28.23]; p=0.004), the need for vasopressor therapy (OR = 3.36 [95%CI, 1.5 to 7.53]; p=0.003) and decision of withholding life support treatments (OR = 19.24 [95%CI, 7.6 to 48.65]; p<0.0001) were associated with bad outcome. Conclusion Our study showed the very poor prognosis of acute stroke patients admitted to ICU. These results also suggest that the clinical evolution of these patients during ICU hospitalization may provide important information for prognostication.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

NCT04434287

Funding Statement

The authors received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

BSR is accredited by the French National Agency of Health surveillance (Santé Publique France) and complies with the French regulation on patient’s consent, ethics, and data confidentiality. Specific authorizations were obtained from the national “Comité consultatif sur le traitement de l’information en matière de recherche” under the reference CCTIRS MG/CP°07.693 and from the “Commission Nationale Informatique et Liberté” (CNIL) under the agreement N° 908085. The local ethic committee also approved the registry. The study protocol was submitted to the Institutional Review Board of the Brest University Hospital (B2020CE.17) and was registered on ClinicalTrials.gov public website (NCT04434287). Patients or relatives were individually informed by postal mail and had the opportunity to decline participation, but no written informed consent was required, in line with the directives of the Ethics Committee.

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Data Availability

All relevant data are within the manuscript and its Supporting Information files.

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