• Mariëlle K van Valburg, Fabian Termorshuizen, Sylvia Brinkman, Wilson F Abdo, Walter M van den Bergh, Janneke Horn, van MookWalther N K AWNKADepartment of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands.National Intensive Care Evaluation Foundation, Amsterdam University Medical Center, Amsterdam, The Netherlands.Department of Medical Informa, Bob Siegerink, SlooterArjen J CAJCDepartment of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.Brain Center Utrecht University, Utrecht, The Netherlands., WermerMarieke J HMJHDepartment of Neurology, Leiden University Medical Center, Leiden, The Netherlands., Bart F Geerts, and M Sesmu Arbous.
• Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands.
• Crit. Care Med. 2020 Oct 1; 48 (10): e876-e883.

ObjectivesAssessment of all-cause mortality of intracerebral hemorrhage and ischemic stroke patients admitted to the ICU and comparison to the mortality of other critically ill ICU patients classified into six other diagnostic subgroups and the general Dutch population.DesignObservational cohort study.SettingAll ICUs participating in the Dutch National Intensive Care Evaluation database.PatientsAll adult patients admitted to these ICUs between 2010 and 2015; patients were followed until February 2017.InterventionsNone.Measurements And Main ResultsOf all 370,386 included ICU patients, 7,046 (1.9%) were stroke patients, 4,072 with ischemic stroke, and 2,974 with intracerebral hemorrhage. Short-term mortality in ICU-admitted stroke patients was high with 30 days mortality of 31% in ischemic stroke and 42% in intracerebral hemorrhage. In the longer term, the survival curve gradient among ischemic stroke and intracerebral hemorrhage patients stabilized. The gradual alteration of mortality risk after ICU admission was assessed using left-truncation with increasing minimum survival period. ICU-admitted stroke patients who survive the first 30 days after suffering from a stroke had a favorable subsequent survival compared with other diseases necessitating ICU admission such as patients admitted due to sepsis or severe community-acquired pneumonia. After having survived the first 3 months after ICU admission, multivariable Cox regression analyses showed that case-mix adjusted hazard ratios during the follow-up period of up to 3 years were lower in ischemic stroke compared with sepsis (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.36) and severe community-acquired pneumonia (adjusted hazard ratio, 1.57; 95% CI, 1.39-1.77) and in intracerebral hemorrhage patients compared with these groups (adjusted hazard ratio, 1.14; 95% CI, 0.98-1.33 and adjusted hazard ratio, 1.49; 95% CI, 1.28-1.73).ConclusionsStroke patients who need intensive care treatment have a high short-term mortality risk, but this alters favorably with increasing duration of survival time after ICU admission in patients with both ischemic stroke and intracerebral hemorrhage, especially compared with other populations of critically ill patients such as sepsis or severe community-acquired pneumonia patients.

24 keywords...

hide…