Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit-A Prospective Cohort Study

Fabio Pilato, Serena Silva, Iacopo Valente, Marisa Distefano, Aldobrando Broccolini, Valerio Brunetti, Pietro Caliandro, Giacomo Della Marca, Riccardo Di Iorio, Giovanni Frisullo, Mauro Monforte, Roberta Morosetti, Carla Piano, Rosalinda Calandrelli, Fioravante Capone, Andrea Alexandre, Alessandro Pedicelli, Cesare Colosimo, Anselmo Caricato, Fabio Pilato, Serena Silva, Iacopo Valente, Marisa Distefano, Aldobrando Broccolini, Valerio Brunetti, Pietro Caliandro, Giacomo Della Marca, Riccardo Di Iorio, Giovanni Frisullo, Mauro Monforte, Roberta Morosetti, Carla Piano, Rosalinda Calandrelli, Fioravante Capone, Andrea Alexandre, Alessandro Pedicelli, Cesare Colosimo, Anselmo Caricato

Abstract

Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20-11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04-10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61-0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92-0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11-0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65-37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency.

Keywords: acute ischemic stroke; neuro-intensive care unit; outcome; thrombectomy; thrombolysis.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patients’ enrollment.
Figure 2
Figure 2
Marginal effect of baseline NIHSS on the probability of a good outcome at 90 days (blue line) and 180 days (red line); the other covariates of the multivariable model are kept fixed. A good outcome is defined as eventual return to home or discharge to assisted living (modified Rankin scale (mRS)

Figure 3

Forest plot showing odds ratios…

Figure 3

Forest plot showing odds ratios of all clinical variable included in the predictive…

Figure 3
Forest plot showing odds ratios of all clinical variable included in the predictive model for a 180-day good outcome.

Figure 4

Marginal effect of age on…

Figure 4

Marginal effect of age on the probability of a good outcome at 180…

Figure 4
Marginal effect of age on the probability of a good outcome at 180 days; the other covariates of the multivariable model are kept fixed. A good outcome is defined as eventual return to home or discharge to assisted living (mRS
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Figure 3
Figure 3
Forest plot showing odds ratios of all clinical variable included in the predictive model for a 180-day good outcome.
Figure 4
Figure 4
Marginal effect of age on the probability of a good outcome at 180 days; the other covariates of the multivariable model are kept fixed. A good outcome is defined as eventual return to home or discharge to assisted living (mRS

References

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