Mortality prediction in critical care for acute stroke: Severity of illness-score or coma-scale?
OBJECTIVE
The use of early prognostic data provided by various scores in critically ill stroke patients remains unclear. We tested the performance of the Simplified Acute Physiology Score (SAPS) II in prediction of mortality of acute stroke patients in the NeuroCriticalCareUnit (NCCU).


METHODS
During one year every patient admitted to the NCCUs at 2 University hospitals for cerebral ischemia (CI) or intracerebral hemorrhage (ICH) and intubated was included in this study. Data for SAPS (I)/II and the Glasgow Coma Scale (GCS) were collected, and mortality at 10 days, 90 days and 1 year was determined. Prognostic performance of all scores was tested by calculation of receiver operating curve (ROC) and by Cox regression analysis.


RESULTS
90 patients were included in the study, 49 with ICH and 41 with CI. Mortality after 10 days was 32.2%, after 3 months 58.9% and after 1 year 67.8%. Compared by their area under curve the predictive values were overall quite good for both SAPS (I) (0.77) and SAPS II (0.77) as well as GCS. Motor subscore was equal to total GCS (0.75 vs. 0.73). In Cox regression models all three scores were independent predictors of fatal outcome.


CONCLUSIONS
SAPS II and SAPS (I) but also the GCS are valuable tools for prediction of short and long-term mortality in acute stroke patients treated in NCCU. The GCS as a predictor for mortality in stroke patients could be further simplified by using its subscore "best motor response" alone.
Handschu
René
R
Dept. of Neurology, Friedrich-Alexander-Universitaet, Schwabachanlage 6, 91054 Erlangen, Germany. rene.handschu@neuro.med.uni-erlangen.de
Haslbeck
Mathias
M
Hartmann
Alexandra
A
Fellgiebel
Andreas
A
Kolominsky-Rabas
Peter
P
Schneider
Dietmar
D
Berrouschot
Jörg
J
Erbguth
Frank
F
Reulbach
Udo
U
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000401:mortality; D003128:Coma / Q000401:mortality*; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000401:mortality*; D013997:Time Factors