What is the prognosis of acute stroke patients requiring ICU admission?

Sonneville, Romain; Gimenez, Laëtitia; Labreuche, Julien; Smonig, Roland; Magalhaes, Eric; Bouadma, Lila; Timsit, Jean‐François; Mazighi, Mikaël

doi:10.1007/s00134-016-4553-7

Cited by 23 publications

(34 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among patients who underwent life support limitation, withdrawal was the predominant limitation category in the stroke population (ischemic strokes, 38/69 (55%); hemorrhagic strokes, 52/68 (76%)), whereas withholding was the most frequent category in the non-brain-injured population (381/695 (55%)). Time from ICU admission to the rst limitation of life support differed between ischemic stroke and hemorrhagic strokes (5 [3][4][5][6][7][8][9] vs 2 [1][2][3][4][5][6] days, p < 0.01). The daily ICU incidence rate of life support limitation according to stroke subtype or absence of brain injury is presented in Fig.…”

Section: Resultsmentioning

confidence: 93%

“…The prognosis of mechanically ventilated stroke patients is poor, with 1-year mortality rates ranging from 60-92% [1][2][3][4][5]. In this subset of extremely severe cases with high fatality rates, a high incidence of limitation (withholding or withdrawal) of life support has been reported, ranging from 30 to 40% [6][7][8] compared to 9-14% in large multicenter observational studies in the general Intensive Care Unit (ICU) population [9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Withholding and Withdrawal of Life Support in Mechanically Ventilated Stroke Patients

Montmollin

Schwebel

Dupuis

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background. The determinants of decisions to limit life support (withholding or withdrawal) in ventilated stroke patients have been poorly investigated.Methods. In a prospective multicenter observational cohort (2005-2016), we evaluated limitation of life support in ventilated stroke patients compared to a non-brain-injured population and identified factors associated with such decisions in stroke patients using Fine and Gray competing risk models.Results. We identified 373 stroke patients (ischemic, n=167 (45%); hemorrhagic, n=206 (55%)), and 5683 non-brain-injured patients. Decisions to limit life support were taken in 41% of ischemic stroke cases (vs. non-brain-injured patients, sHR 3.59 [95% CI 2.78-4.65]) and in 33% of hemorrhagic stroke cases (vs. non-brain-injured patients, sHR 3.9 [95% CI 2.97-5.11]). Time from ICU admission to the first limitation was longer in ischemic than in hemorrhagic stroke (5 [3 - 9] vs 2 [1 - 6] days, p<0.01). Limitation of life support preceded ICU death in 70% of ischemic strokes and 45% of hemorrhagic strokes (p<0.01). Life support limitation in ischemic stroke was associated with a vertebrobasilar location (vs. anterior circulation, sHR, 1.61 [95% CI 1.01 - 2.59]) and in hemorrhagic stroke, it was associated with an age>70 years (2.29 [1.43 - 3.69]), a Glasgow score<8 (2.15 [1.08 - 4.3]) and a lower non-neurologic admission SOFA score (per point, 0.89 [0.82 - 0.97]).Conclusions. In ventilated stroke patients, decisions to limit life support are more than 3 times more frequent than in non-brain injured patients, with different timing and associated risk factors between ischemic and hemorrhagic strokes.

show abstract

Section: Resultsmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Withholding and Withdrawal of Life Support in Mechanically Ventilated Stroke Patients

Montmollin

Schwebel

Dupuis

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…[31] However, due to the increasing complexity of stroke treatment and severe conditions, an increasing proportion of acute stroke patients are being admitted to an ICU. [32,33] A study including 4958 consecutive stroke patients reported 347 (7.0%) patients required ICU admission at any time point during their index hospitalization. [4] In-hospital mortality of ICU stroke reported in the literature varies widely, highly depending on the patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…A previous small study found the mortality was 38.7% (43/111) in stroke patients requiring ICU admission. [32] An United States study including 448 ICU stroke patients provided hospital mortality was 30%. [34] Recently, a prospective observation trial reported the mortality was 7.5% in critically ill stroke patients.…”

Section: Discussionmentioning

confidence: 99%

“…[35] These patients with high hospital mortality mainly associated with older age, poor neurological severity at admission, high APACHE score, impaired consciousness, intracranial hemorrhage and need for mechanical ventilation. [32,33] Moreover, functional outcomes in survivors appear to be poor. [36] The current study based on eICU database, indicated the hospital and ICU mortality were 10.3% and 5.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Triglyceride-glucose index linked to hospital mortality in critically ill stroke patients: an observational multicentre study on eICU database

Zhang

Liu

Ruan

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The triglyceride‑glucose (TyG) index is a reliable surrogate of insulin resistance and a marker for ischemic stroke (IS) incident. Whether the TyG index predicts stroke outcome remains uncertain. This study investigated the prognostic value of the TyG index in critically ill stroke patients.Methods: This was a retrospective observational study that included stroke patients, and all data were extracted from the eICU Collaborative Research Database. The TyG index was calculated as the ln (fasting glucose level [mg/dL] × triglyceride level [mg/dL]/2). The outcomes included the hospital and intensive care unit (ICU) death. Multivariate logistic regression was used to determine independent risk factors. The smoothing curves and forest plots were illustrated.Results: A total of 4570 eligible subjects were enrolled. The mean level of TyG index was 9.1 ± 0.7. The hospital and ICU mortality rate were 10.3% and 5.0% respectively. TyG index as a continuous variable was associated hospital mortality in univariate analysis (OR 1.723, 95% CI 1.524-1.948, P < 0.001), adjusted model 1 (OR 1.861, 95% CI 1637-2.116, P < 0.001) and adjusted model 2 (OR 2.543, 95% CI 1.588-4.073, P < 0.001). TyG was also associated ICU mortality in univariate analysis (OR 2.146, 95% CI 1.826-2.523, P < 0.001), adjusted model 1 (OR 2.183, 95% CI 1.847-2.580, P < 0.001), and adjusted model 2 (OR 2.672, 95% CI 1.376-5.188, P < 0.001). The smoothing curves observed a continuous linear association after adjusting all covariates both in hospital and ICU mortality. Subgroup analysis demonstrated TyG index was associated with increased risk of hospital and ICU death in critically ill IS (P < 0.05), but not in hemorrhage stroke (P > 0.05).Conclusion: The TyG index is a potential predictor for hospital and ICU mortality in critically ill stroke patients, especially in IS patients.

show abstract

Outcomes of Acute Stroke Patients Requiring Mechanical Ventilation: Study Protocol for the SPICE Multicenter Prospective Observational Study

et al. 2020

View full text Add to dashboard Cite

What is the prognosis of acute stroke patients requiring ICU admission?

Cited by 23 publications

References 5 publications

Withholding and Withdrawal of Life Support in Mechanically Ventilated Stroke Patients

Withholding and Withdrawal of Life Support in Mechanically Ventilated Stroke Patients

Triglyceride-glucose index linked to hospital mortality in critically ill stroke patients: an observational multicentre study on eICU database

Outcomes of Acute Stroke Patients Requiring Mechanical Ventilation: Study Protocol for the SPICE Multicenter Prospective Observational Study

Contact Info

Product

Resources

About