Outcome predictors after acute stroke in Egyptian patients admitted to the ICU (OPASEP study)

Abstract

Introduction ‘Stroke’ is the term commonly used to describe the sudden onset of a neurological deficit such as weakness or paralysis due to disturbance of the blood flow to the brain. The term is applied loosely to cover ischemic and hemorrhagic episodes. Objective The aim of this study was to evaluate the predictors of poor outcome after either acute ischemic or hemorrhagic stroke among patients throughout 30 days after their admission to ICUs at Alexandria Hospitals. Patients and methods In this prospective observational study, 817 patients were enrolled over a period of 6 months from critical care units at Alexandria University hospitals, ‘either free hospitals, insured hospitals or paid hospitals,’ as well as nongovernmental insurance hospitals. Cases included patients with acute stroke, either acute ischemic stroke or hemorrhagic stroke. Patients with Glasgow outcome scale (severe disability, vegetative, or dead) were considered to have poor prognosis. Results Poor prognosis occurred in 56.5% of patients (461/817 patients). Overall, 47.5% of patients had ventilator-associated pneumonia (VAP), 42.5% had seizures, 21.3% had deep vein thrombosis, and 25.7% of patients developed acute kidney injury (AKI). The most significant predictors of poor outcome included development of hospital-acquired pneumonia/VAP [odds ratio (OR) 128.871; 95% confidence interval (CI) 67.253–246.941; P<0.001], occurrence of bed sores (OR 10.287; 95% CI 5.865–18.045; P<0.001), occurrence of bloodstream infections (OR 4.463; 95% CI 2.445–8.147; P<0.001), occurrence of seizures (OR 4.005; 95% CI 2.35–6.826; P<0.001), and occurrence of AKI (OR 3.532; 95% CI 1.944–6.416; P=0.001), which were significantly associated with poor outcomes. Conclusion The poorest prognostic factors for patients with acute stroke are development of hospital-acquired pneumonia or VAP, followed by development of bed sores, occurrence of bloodstream infection, and occurrence of AKI.