Predicting 30-day mortality in intensive care unit patients with ischaemic stroke or intracerebral haemorrhage

Mariëlle K van Valburg, Fabian Termorshuizen, Bart F Geerts, Wilson F Abdo, Walter M van den Bergh, Sylvia Brinkman, Janneke Horn, Walther N K A van Mook, Arjen J C Slooter, Marieke J H Wermer, Bob Siegerink, M Sesmu Arbous

Onderzoeksoutput: Articlepeer review

Samenvatting

BACKGROUND: Stroke patients admitted to an intensive care unit (ICU) follow a particular survival pattern with a high short-term mortality, but if they survive the first 30 days, a relatively favourable subsequent survival is observed.

OBJECTIVES: The development and validation of two prognostic models predicting 30-day mortality for ICU patients with ischaemic stroke and for ICU patients with intracerebral haemorrhage (ICH), analysed separately, based on parameters readily available within 24 h after ICU admission, and with comparison with the existing Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) model.

DESIGN: Observational cohort study.

SETTING: All 85 ICUs participating in the Dutch National Intensive Care Evaluation database.

PATIENTS: All adult patients with ischaemic stroke or ICH admitted to these ICUs between 2010 and 2019.

MAIN OUTCOME MEASURES: Models were developed using logistic regressions and compared with the existing APACHE-IV model. Predictive performance was assessed using ROC curves, calibration plots and Brier scores.

RESULTS: We enrolled 14 303 patients with stroke admitted to ICU: 8422 with ischaemic stroke and 5881 with ICH. Thirty-day mortality was 27% in patients with ischaemic stroke and 41% in patients with ICH. Important factors predicting 30-day mortality in both ischaemic stroke and ICH were age, lowest Glasgow Coma Scale (GCS) score in the first 24 h, acute physiological disturbance (measured using the Acute Physiology Score) and the application of mechanical ventilation. Both prognostic models showed high discrimination with an AUC 0.85 [95% confidence interval (CI), 0.84 to 0.87] for patients with ischaemic stroke and 0.85 (0.83 to 0.86) in ICH. Calibration plots and Brier scores indicated an overall good fit and good predictive performance. The APACHE-IV model predicting 30-day mortality showed similar performance with an AUC of 0.86 (95% CI, 0.85 to 0.87) in ischaemic stroke and 0.87 (0.86 to 0.89) in ICH.

CONCLUSION: We developed and validated two prognostic models for patients with ischaemic stroke and ICH separately with a high discrimination and good calibration to predict 30-day mortality within 24 h after ICU admission.

TRIAL REGISTRATION: Trial registration: Dutch Trial Registry ( https://www.trialregister.nl/ ); identifier: NTR7438.

Originele taal-2English
Pagina's (van-tot)136-145
Aantal pagina's10
TijdschriftEuropean Journal of Anaesthesiology
Volume41
Nummer van het tijdschrift2
DOI's
StatusPublished - feb 2024

Bibliografische nota

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

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