Prediction of the survival and functional ability of severe stroke patients after ICU therapeutic intervention.
BACKGROUND
This study evaluated the benefits and impact of ICU therapeutic interventions on the survival and functional ability of severe cerebrovascular accident (CVA) patients.


METHODS
Sixty-two ICU patients suffering from severe ischemic/haemorrhagic stroke were evaluated for CVA severity using APACHE II and the Glasgow coma scale (GCS). Survival was determined using Kaplan-Meier survival tables and survival prediction factors were determined by Cox multivariate analysis. Functional ability was assessed using the stroke impact scale (SIS-16) and Karnofsky score. Risk factors, life support techniques and neurosurgical interventions were recorded. One year post-CVA dependency was investigated using multivariate analysis based on linear regression.


RESULTS
The study cohort constituted 6% of all CVA (37.8% haemorrhagic/62.2% ischemic) admissions. Patient mean(SD) age was 65.8(12.3) years with a 1:1 male: female ratio. During the study period 16 patients had died within the ICU and seven in the year following hospital release. The mean(SD) APACHE II score at hospital admission was 14.9(6.0) and ICU mean duration of stay was 11.2(15.4) days. Mechanical ventilation was required in 37.1% of cases. Risk ratios were; GCS at admission 0.8(0.14), (p = 0.024), APACHE II 1.11(0.11), (p = 0.05) and duration of mechanical ventilation 1.07(0.07), (p = 0.046). Linear coefficients were: type of CVA - haemorrhagic versus ischemic: -18.95(4.58) (p = 0.007), GCS at hospital admission: -6.83(1.08), (p = 0.001), and duration of hospital stay -0.38(0.14), (p = 0.40).


CONCLUSIONS
To ensure a better prognosis CVA patients require ICU therapeutic interventions. However, as we have shown, where tests can determine the worst affected patients with a poor vital and functional outcome should treatment be withheld?
Riachy
Moussa
M
Department of Pulmonary and Critical Care Medicine, Hotel Dieu de France, Beirut, Lebanon. riachy@dm.net.lb
Sfeir
Frida
F
Sleilaty
Ghassan
G
Hage-Chahine
Samer
S
Dabar
Georges
G
Bazerbachi
Taha
T
Aoun-Bacha
Zeina
Z
Khayat
Georges
G
Koussa
Salam
S
D018806:APACHE; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D016893:Carotid Stenosis / Q000453:epidemiology; D015984:Causality; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000145:classification / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate