Association between critical care admission and 6-month functional outcome after spontaneous intracerebral haemorrhage.

Cerebral Hemorrhage / complications Critical Care Glasgow Coma Scale Humans Prospective Studies Quality of Life Treatment Outcome
Critical care Intensive care Modified Rankin scale (mRS) functional outcome Spontaneous intracerebral haemorrhage

Journal

Journal of the neurological sciences
ISSN: 1878-5883
Titre abrégé: J Neurol Sci
Pays: Netherlands
ID NLM: 0375403

Informations de publication

Date de publication:
15 Nov 2020
Historique:
received: 12 06 2020
revised: 11 09 2020
accepted: 12 09 2020
pubmed: 26 9 2020
medline: 15 5 2021
entrez: 25 9 2020
Statut: ppublish

Résumé

There is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH). We investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome. We included 825 patients with acute spontaneous non-traumatic ICH, recruited to a prospective multicenter observational study. We evaluated the characteristics associated with critical care admission and poor 6-month functional outcome (modified Rankin Scale, mRS > 3) using univariable (chi-square test and Wilcoxon rank-sum test, as appropriate) and multivariable analysis. 286 patients (38.2%) had poor 6-month functional outcome. Seventy-seven (9.3%) patients were admitted to critical care. Patients admitted to critical care were younger (p < 0.001), had lower GCS score (p < 0.001), larger ICH volume (p < 0.001), more often had intraventricular extension (p = 0.008) and underwent neurosurgery (p < 0.001). Critical care admission was associated with poor functional outcome at 6 months (39/77 [50.7%] vs 286/748 [38.2%]; p = 0.034); adjusted OR 2.43 [95%CI 1.36-4.35], p = 0.003), but not with death (OR 1.29 [95%CI 0.71-2.35; p = 0.4). In ordinal logistic regression, patients admitted to critical care showed an OR 1.47 (95% CI 0.98-2.20; p = 0.07) for a shift in the 6-month modified Rankin Scale. Admission to critical care is associated with poor 6-month functional outcome after spontaneous ICH but not with death. Patients admitted to critical care were a priori more severely affected. Although adjusted for main known predictors of poor outcome, our findings could still be confounded by unmeasured factors. Establishing the true effectiveness of critical care after ICH requires a randomised trial with clinical outcomes and quality of life assessments.

Sections du résumé

BACKGROUND BACKGROUND
There is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH).
PURPOSE OBJECTIVE
We investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome.
METHODS METHODS
We included 825 patients with acute spontaneous non-traumatic ICH, recruited to a prospective multicenter observational study. We evaluated the characteristics associated with critical care admission and poor 6-month functional outcome (modified Rankin Scale, mRS > 3) using univariable (chi-square test and Wilcoxon rank-sum test, as appropriate) and multivariable analysis.
RESULTS RESULTS
286 patients (38.2%) had poor 6-month functional outcome. Seventy-seven (9.3%) patients were admitted to critical care. Patients admitted to critical care were younger (p < 0.001), had lower GCS score (p < 0.001), larger ICH volume (p < 0.001), more often had intraventricular extension (p = 0.008) and underwent neurosurgery (p < 0.001). Critical care admission was associated with poor functional outcome at 6 months (39/77 [50.7%] vs 286/748 [38.2%]; p = 0.034); adjusted OR 2.43 [95%CI 1.36-4.35], p = 0.003), but not with death (OR 1.29 [95%CI 0.71-2.35; p = 0.4). In ordinal logistic regression, patients admitted to critical care showed an OR 1.47 (95% CI 0.98-2.20; p = 0.07) for a shift in the 6-month modified Rankin Scale.
CONCLUSIONS CONCLUSIONS
Admission to critical care is associated with poor 6-month functional outcome after spontaneous ICH but not with death. Patients admitted to critical care were a priori more severely affected. Although adjusted for main known predictors of poor outcome, our findings could still be confounded by unmeasured factors. Establishing the true effectiveness of critical care after ICH requires a randomised trial with clinical outcomes and quality of life assessments.

Identifiants

DOI: 10.1016/j.jns.2020.117141 PMID: 32977232
pubmed: 32977232
pii: S0022-510X(20)30478-0
doi: 10.1016/j.jns.2020.117141
pii:
doi:

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

117141

Subventions

Organisme : Medical Research Council
ID : G1002605
Pays : United Kingdom
Organisme : Medical Research Council
ID : G108/613
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/M009106/1
Pays : United Kingdom

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Auteurs

Siobhan Mc Lernon (S)

Stroke Research Centre, University College London, Institute of Neurology, London, UK; London South Bank University, School of Health and Social Care, London, UK. Electronic address: mclernt@lsbu.ac.uk.

Ghil Schwarz (G)

Stroke Research Centre, University College London, Institute of Neurology, London, UK; Department of Neurology, Stroke Unit San Raffaele Hospital, Milan, Italy.

Duncan Wilson (D)

Stroke Research Centre, University College London, Institute of Neurology, London, UK.

Gareth Ambler (G)

Department of Statistical Science, University College London, Gower Street, London, UK.

Russell Goodwin (R)

London South Bank University, School of Health and Social Care, London, UK.

Clare Shakeshaft (C)

Stroke Research Centre, University College London, Institute of Neurology, London, UK.

Hannah Cohen (H)

Haemostasis Research Unit, Department of Haematology, University College London, 51 Chenies Mews, London, UK.

Tarek Yousry (T)

Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.

Rustam Al-Shahi Salman (R)

Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK.

Gregory Y H Lip (GYH)

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Henry Houlden (H)

Department of Molecular Neuroscience, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.

Martin M Brown (MM)

Stroke Research Centre, University College London, Institute of Neurology, London, UK.

Keith W Muir (KW)

Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.

Hans Rolf Jäger (HR)

Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.

Louise Terry (L)

London South Bank University, School of Health and Social Care, London, UK.

David J Werring (DJ)

Stroke Research Centre, University College London, Institute of Neurology, London, UK.

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hémorragies intracrâniennes › Hémorragie cérébrale › Association between critical care admission...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins de réanimation › Association between critical care admission...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Échelle de coma de Glasgow › Association between critical care admission...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Association between critical care admission...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Association between critical care admission...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Association between critical care admission...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Association between critical care admission...