Introduction
Materials and methods
Patients and setting
All | Ischemia | ICH | SAH | Meningoencephalitis | Epilepsy | GBS/MG | Neurodeg/Encephalopathy | Neoplasm | Intoxication | Temporarily monitored | |
---|---|---|---|---|---|---|---|---|---|---|---|
n (%) | 733 | 247 (33.7) | 210 (27.4) | 38 (5.2) | 49 (6.7) | 93 (12.7) | 25 (3.4) | 22 (3.0) | 22 (3.0) | 27 (3.7) |
63
|
Age (median, range) | 67 (18 to 95) | 72 (21 to 93) | 70 (35 to 95) | 56 (19 to 84) | 63 (27 to 85) | 59 (18 to 93) | 58 (23 to 78) | 66 (23 to 90) | 65 (39 to 78) | 53 (29 to 78) |
51 (33 to 68)
|
Female sex (n, %) | 350 (47.7) | 111 (44.9 ) | 100 (47.6) | 20 (52.6) | 26 (53.1) | 48 (51.6) | 14 (56) | 14 (63.6) | 8 (36.4) | 9 (33.3) |
26 (41.3)
|
Pre-hospital mRS 0 to 2 n (%) | 635 (86.6) | 227 (91.9) | 198 (94.3) | 37 (97.4) | 43 (87.8) | 71 (76.3) | 24 (96.0) | 8 (36.4) | 4 (18.2) | 23 (85.2) |
47 (74.6)
|
Hospital length of stay in days (median, range) | 4 (0 to 87) | 4 (0 to 57) | 5 (0 to 53) | 4 (0 to 63) | 4 (0 to 84) | 1 (0 to 87) | 6 (0 to 57) | 3 (1 to 50) | 3 (0 to 17) | 3 (0 to 19) |
1 (0 to 2)
|
Mechanichal ventilation (n, %) | 450 (61.4) | 148 (59.9) | 140 (66.7) | 20 (52.6) | 42 (85.7) | 48 (51.6) | 16 (64.0) | 18 (81.8) | 8 (36.4) | 20 (74.1) |
18 (28.6)
|
Length of ventilation (d) (median, range) | 3 (0 to 83) | 4 (0 to 43) | 5 (0 to 53) | 1(0 to 60) | 4 (0 to 83) | 0 (0 to 63) | 6 (0 to 49) | 3 (0 to 50) | 0 (0 to 13) | 3 (0 to 14) |
0 (0 to 1)
|
DNT (n, %) |
38 (5.1)
|
9 (3.6)
|
22 (10.5)
|
3 (7.9)
|
0
|
0
|
0
|
2 (9.1)
|
2 (9.1)
|
0
|
0
|
Lost to follow-up (n, %) |
29 (4.0)
|
6 (2.4)
|
5 (2.4)
|
1 (2.6)
|
2 (4.1)
|
7 (7.5)
|
1 (4)
|
2 (9.1)
|
3 (13.6)
|
2 (7.4)
|
16 (25.4)
|
In-hospital mortality (n, %) | 165 (22.5) | 53 (21.5) | 75 (35.7) | 12 (31.6) | 3 (6.1) | 5 (5.4) | 1 (4.0) | 4 (18.2) | 7 (31.8) | 5 (18.5) |
0
|
Mortality after 1 year (n, %) | 292 (39.8) | 100 (41.5) | 121 (59.0) | 18 (48.6) | 6 (12.8) | 14 (16.3) | 1 (4.2) | 11 (55.0) | 15 (78.9) | 6 (24.6) |
1 (2.1)
|
mRS 0 to 2 after 1 year (n, %) | 208 (28.4) | 33 (13.7) | 40 (19.5) | 11 (29.7) | 28 (59.6) | 57 (66.3) | 16 (66.7) | 5 (25.0) | 1 (5.3) | 17 (68.0) |
38 (80.9)
|
Data collection and outcome analysis
Statistical analysis
Results
Analysis of all patients admitted to the neurocritical care unit (Intention-to-treat population)
Analysis of patients receiving specialized neurocritical care (per protocol population)
Prediction of good functional long-term outcome after neurocritical care
Good outcome (mRS ≤ 2) | |||
---|---|---|---|
Exp(Coef) | 95% CI | P-value | |
Univariate
| |||
Age | 0.834 | 0.794 to 0.872 | < 0.0001 |
SEX (female) | 1.265 | 0.554 to 1.864 | 0.57645 |
Hospital LOS
|
0.759
|
0.281 to 0.866
|
0.04397
|
Length of ventilation
|
0.410
|
0.113 to 0.641
|
0.01202
|
Length of ventilation (per increasing day)
|
0.974
|
0.913 to 1.061
|
0.09441
|
TISS-28 on Day 1 | |||
< 21 |
2.746
|
1.935 to 4.391
|
0.00666
|
20 to 40 |
1.273
|
0.764 to 1.812
|
0.21932
|
> 40 |
0.715
|
0.621 to 0.944
|
0.00181
|
TISS-28 at discharge | |||
< 21 |
2.187
|
1.453 to 3.812
|
0.01215
|
20 to 40 |
1.234
|
0.218 to 2.187
|
0.23156
|
> 40 |
0.711
|
0.451 to 0.857
|
0.00017
|
Ischemia
|
0.724
|
0.485 to 0.932
|
0.04275
|
ICH
|
0.743
|
0.573 to 0.935
|
0.02046
|
SAH | 0.636 | 0.273 to 1.198 | 0.63532 |
Meningoencephalitis | 1.412 | 0.996 to 3.238 | 0.12432 |
Epilepsy | 1.433 | 0.233 to 2.346 | 0.73255 |
GBS/MG
|
3.623
|
1.124 to 13.327
|
0.00145
|
Neurodeg./Encephalopathy
|
0.680
|
0.274 to 1.019
|
0.05723
|
Neoplasm
|
0.692
|
0.371 to 0.856
|
0.00039
|
Intoxication
|
5.809
|
1.832 to 7.483
|
0.03881
|
Multivariate
| |||
Age
| 0.786 | 0.435 to 0.823 | 0.00245 |
Hospital LOS | 0.509 | 0.272 to 1.279 | 0.17647 |
Length of ventilation
|
0.681
|
0.475 to 0.912
|
0.00354
|
TISS-28 on Day 1 > 40
|
0.815
|
0.578 to 0.931
|
0.00187
|
Ischemia | 0.345 | 0.245 to 1.101 | 0.11458 |
ICH
|
0.643
|
0.218 to 0.877
|
0.03874
|
GBS/MG
|
2.215
|
2.006 TO 3.214
|
0.03329
|
Neurodeg./Encephalopathy | 0.705 | 0.297 to 1.354 | 0.15478 |
Neoplasm
|
0.687
|
0.354 to 0.934
|
0.04875
|
Intoxication | 1.399 | 0.964 to 2.648 | 0.27261 |
Discussion
Mortality
Functional outcome and outcome-predicting diseases
Length of ventilation
Limitations
Conclusions
Key messages
-
In neurocritical care, disease-specific prognostic information on clinical course and functional outcome are needed to guide neurocritical care physicians in their identification process of patients who benefit from neurocritical care.
-
In this large, consecutive neurointensive care patient cohort, the diseases GBS and MG were independently related to a good long-term outcome, whereas older age and increased length of ventilation as well as the diagnoses ICH and cerebral neoplasm were predisposing factors for an unfavorable outcome.