Outcome of Stroke Patients Admitted to Intensive Care: Experience from an Australian Teaching Hospital

The objective of this study was to determine the mortality rate and the functional outcomes of stroke patients admitted to the intensive care unit (ICU) and to identify predictors of poor outcome in this population. The records of all patients admitted to the ICU with the diagnosis of stroke between January 1994 and December 1999 were reviewed. Patients with subarachnoid haemorrhage were excluded. Data were collected on clinical and biological variables, risk factors for stroke and the presence of comorbidities. Mortality (ICU, in-hospital and three-month) and functional outcome were used as end-points. In the six-year-period, 61 patients were admitted to the ICU with either haemorrhagic or ischaemic stroke. Medical records were available for only 58 patients. There were 23 ischaemic and 35 haemorrhagic strokes. The ICU, in-hospital and three-month mortality rates were 36%, 47% and 52% respectively. There were no significant differences in the prevalence of premorbid risk factors between survivors and non-survivors. The mean Barthel score was significantly different between the independent and dependent survivors (94±6 vs 45±26, P<0.001). A substantial number of patients with good functional outcomes had lower Rankin scores (92% vs 11%, P<0.001). Only 46% of those who were alive at three months were functionally independent. Intensive care admission was associated with a high mortality rate and a high likelihood of dependent lifestyle after hospital discharge. Haemorrhagic stroke, fixed dilated pupil(s) and GCS <10 during assessment were associated with increased mortality and poor functional outcome.

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Stroke study group: preliminary results early intensive care improves functional outcome

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1994000300008 ◽

1994 ◽

Vol 52 (3) ◽

pp. 330-338

Author(s):

Fernando Faria Andrade Figueira

Keyword(s):

Intensive Care ◽

Emergency Room ◽

Functional Outcome ◽

Functional Outcomes ◽

Mortality Rates ◽

Study Group ◽

Stroke Patients ◽

Standardized Protocol ◽

Stroke Study ◽

Stroke Study Group

Early and intensive care seems to positively affect outcome in stroke patients. A standardized protocol, costly adjusted to our reality and suitable for application by non-specialist at Emergency Room, proved effective, reflecting in diagnosis reliability, reducing time for beginning therapy, leading to low mortality rates and better functional outcomes at discharge.

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Population-based assessment of intensive care unit-acquired bloodstream infections in adults: Incidence, risk factors, and associated mortality rate

Critical Care Medicine ◽

10.1097/00003246-200211000-00010 ◽

2002 ◽

Vol 30 (11) ◽

pp. 2462-2467 ◽

Cited By ~ 77

Author(s):

Kevin B. Laupland ◽

David A. Zygun ◽

H. Dele Davies ◽

Deirdre L. Church ◽

Thomas J. Louie ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Bloodstream Infections ◽

Population Based ◽

Incidence Risk

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A National Strategy to Diagnose Coronavirus Disease 2019–Associated Invasive Fungal Disease in the Intensive Care Unit

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1298 ◽

2020 ◽

Cited By ~ 6

Author(s):

P Lewis White ◽

Rishi Dhillon ◽

Alan Cordey ◽

Harriet Hughes ◽

Federica Faggian ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Mortality Rate ◽

Respiratory Distress ◽

Antifungal Therapy ◽

Invasive Fungal Disease ◽

Chronic Respiratory Disease ◽

Fungal Disease ◽

Antifungal Prophylaxis ◽

Severe Respiratory Distress

Abstract Background Fungal coinfection is a recognized complication of respiratory virus infections, increasing morbidity and mortality, but can be readily treated if diagnosed early. An increasing number of small studies describing aspergillosis in coronavirus disease 2019 (COVID-19) patients with severe respiratory distress are being reported, but comprehensive data are lacking. The aim of this study was to determine the incidence, risk factors, and impact of invasive fungal disease in adult COVID-19 patients with severe respiratory distress. Methods An evaluation of a national, multicenter, prospective cohort evaluation of an enhanced testing strategy to diagnose invasive fungal disease in COVID-19 intensive care patients. Results were used to generate a mechanism to define aspergillosis in future COVID-19 patients. Results One-hundred and thirty-five adults (median age: 57, M/F: 2.2/1) were screened. The incidence was 26.7% (14.1% aspergillosis, 12.6% yeast infections). The overall mortality rate was 38%; 53% and 31% in patients with and without fungal disease, respectively (P = .0387). The mortality rate was reduced by the use of antifungal therapy (mortality: 38.5% in patients receiving therapy vs 90% in patients not receiving therapy (P = .008). The use of corticosteroids (P = .007) and history of chronic respiratory disease (P = .05) increased the likelihood of aspergillosis. Conclusions Fungal disease occurs frequently in critically ill, mechanically ventilated COVID-19 patients. The survival benefit observed in patients receiving antifungal therapy implies that the proposed diagnostic and defining criteria are appropriate. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of COVID-19 patients.

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Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

European Respiratory Review ◽

10.1183/16000617.0061-2018 ◽

2018 ◽

Vol 27 (150) ◽

pp. 180061 ◽

Cited By ~ 5

Author(s):

Julio A. Huapaya ◽

Erin M. Wilfong ◽

Christopher T. Harden ◽

Roy G. Brower ◽

Sonye K. Danoff

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Interstitial Lung Disease ◽

Mortality Rate ◽

Lung Disease ◽

Mortality Rates ◽

Population Heterogeneity

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

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Can clinical risk factors predict functional recovery in ischemic stroke patients with pre-stroke depression?

10.21203/rs.2.10087/v1 ◽

2019 ◽

Author(s):

Leah Wormack ◽

Brice Blum ◽

Benjamin Bailes ◽

Thomas Nathaniel

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Outcome ◽

Clinical Risk Factors ◽

Stroke Patients ◽

Antihypertensive Medications ◽

Clinical Risk ◽

Predictive Variables ◽

Stroke Population ◽

Thrombolysis Therapy

Abstract Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 – 104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 –43.529, P=0.019),previous TIA (OR= 0.444, 95% CI, 0.517 –0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 –0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

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Abstract 3275: Early Neurological Improvement After Intravenous Thrombolysis in Acute Stroke Predicts Long-Term Functional Outcome

Stroke ◽

10.1161/str.43.suppl_1.a3275 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Leonard L Yeo ◽

Liang Shen ◽

Ben Wakerley ◽

Aftab Ahmad ◽

Kay W Ng ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Symptom Onset ◽

Functional Outcomes ◽

Treatment Time ◽

Favorable Outcome ◽

Stroke Patients ◽

Neurological Improvement ◽

Iv Tpa

Background: Intravenously administered tissue plasminogen activator (IV-TPA) remains the only approved therapeutic agent for arterial recanalization in acute ischemic stroke (AIS). Wide variations in the rates and timing of neurological recovery are observed in thrombolyzed patients. While all IV-TPA treated patients are routinely evaluated for neurological recovery at 24-hours, considerable improvement occurs in some cases within 2-hours of treatment initiation. We evaluated whether early neurological improvement at 2-hours after IV-TPA bolus (ENI-2) can predict functional outcomes in thrombolyzed AIS patients at 3-months. Methods: Data for consecutive stroke patients treated with IV-TPA within 4.5 hours of symptom-onset during 2007-2010 were prospectively entered in the thrombolyzed registry maintained at our tertiary care center. Data were collected for demographic characteristics, vascular risk factors, stroke subtypes and blood pressure levels before IV-TPA bolus. National Institute of Health Stroke Scale (NIHSS) scores were obtained before IV-TPA bolus and at 2-hours. ENI-2 was defined as a reduction in NIHSS score by more than 10-points from baseline score or an absolute score of 4-points or less at 2-hours after IV-TPA bolus. Functional outcomes at 3-months were determined by modified Rankin scale (mRS). Data were analyzed by SPSS 19.0. Results: Of the 2238 AIS patients admitted during the study period, 240 (11%) received IV-TPA within 4.5-hours of symptom-onset. Median age was 65yrs (range 19-92), 63% males, median NIHSS 17points (range 3-35) and median onset-to-treatment time 149 minutes. Overall, 122 (50.8%) patients achieved favorable functional outcome (mRS 0-1) at 3-months. Factors associated with favorable outcome at 3-months on univariable analysis were younger age, female gender, presence of atrial fibrillation, baseline NIHSS, onset-to-treatment time (OTT) and ENI-2. However, multivariable analysis demonstrated NIHSS at onset (OR per 1-point increase 0.907, 95%CI 0.848-0.969) and ENI-2 (OR 4.926 95%CI 1.66-15.15) as independent predictors of favorable outcome at 3-months. Conclusion: Early Neurological improvement at 2-hours after IV-TPA bolus is a strong predictor of the functional outcome at 3-months in acute ischemic stroke patients.

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Epidemiologic features, risk factors, and outcome of sepsis in stroke patients treated on a neurologic intensive care unit

Journal of Critical Care ◽

10.1016/j.jcrc.2013.11.001 ◽

2014 ◽

Vol 29 (2) ◽

pp. 241-248 ◽

Cited By ~ 14

Author(s):

Benjamin Berger ◽

Christoph Gumbinger ◽

Thorsten Steiner ◽

Marek Sykora

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Stroke Patients ◽

Epidemiologic Features ◽

Neurologic Intensive Care Unit

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Cholestasis sepsis at neonatology ward and neonatal Intensive Care Unit Cipto Mangunkusumo Hospital 2007 : incidence, mortality rate and associated risk factors

Medical Journal of Indonesia ◽

10.13181/mji.v17i2.306 ◽

2008 ◽

pp. 107

Author(s):

Kadim S. Bachtiar ◽

Hanifah Oswari ◽

Jose R.L. Batubara ◽

Idham Amir ◽

Abdul Latief ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Associated Risk Factors

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Seasonality, Epidemiology and Outcome of Congenital Diaphragmatic Hernia in South West of Iran

Journal of Neonatal Surgery ◽

10.21699/jns.v6i2.506 ◽

2017 ◽

Vol 6 (2) ◽

pp. 28 ◽

Cited By ~ 1

Author(s):

Masoud Dehdashtian ◽

Shiva Bashirnejad ◽

Arash Malekian ◽

Mohammad Reza Aramesh ◽

Mohammad Hasan Aletayeb

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Seasonal Variation ◽

Mortality Rate ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Neonatal Intensive Care ◽

South West ◽

Very High

Introduction: The pathogenesis of congenital diaphragmatic hernia (CDH) is not clear. Risk factors including environmental factors have been implicated in the pathogenesis of few congenital anomalies. We aimed to assess the effect of season on the incidence of CDH and mortality rate in the southwest of Iran.Material and Methods: In this retrospective study, the records of 60 patients with CDH who were admitted at Neonatal Intensive Care Unit (NICU) of Imam Khomeini Hospital of Ahvaz, Iran were evaluated.Results: Assuming that all the neonates born with CDH in the region reach this hospital, overall CDH prevalence rate was 1.09 per 10 000 total births. Conceptions in spring and summer in this region had statistically significantly higher incidence of CDH. Survival rate in the series was 41.6%.Conclusion: Seasonal variation has impact on the incidence of CDH. Mortality rate in neonates with CDH is still very high.

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