Prediction of in-hospital stroke mortality in critical care unit

Wei-Min Ho; Jr-Rung Lin; Hui-Hsuan Wang; Chia-Wei Liou; Ku-Chou Chang; Jiann-Der Lee; Tsung-Yi Peng; Jen-Tsung Yang; Yeu-Jhy Chang; Chien-Hung Chang; Tsong-Hai Lee

doi:10.1186/s40064-016-2687-2

Prediction of in-hospital stroke mortality in critical care unit

Springerplus. 2016 Jul 11;5(1):1051. doi: 10.1186/s40064-016-2687-2. eCollection 2016.

Authors

Wei-Min Ho¹, Jr-Rung Lin², Hui-Hsuan Wang³, Chia-Wei Liou⁴, Ku-Chou Chang⁴, Jiann-Der Lee⁵, Tsung-Yi Peng⁶, Jen-Tsung Yang⁷, Yeu-Jhy Chang⁸, Chien-Hung Chang⁸, Tsong-Hai Lee⁸

Affiliations

¹ Dementia Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333 Taiwan, ROC.
² Clinical Informatics and Medical Statistics Research Center, Chang Gung University, No.261, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan, ROC.
³ Department of Healthcare Management, College of Management, Chang Gung University, No.261, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan, ROC.
⁴ Stroke Center and Department of Neurology, Kaohsiung Medical Center, Chang Gung Memorial Hospital, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833 Taiwan, ROC.
⁵ Stroke Center and Department of Neurology, Chiayi Medical Center, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, 613 Chiayi County Taiwan, ROC.
⁶ Department of Neurology, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan, ROC.
⁷ Department of Neurosurgery, Chiayi Medical Center, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, 613 Chiayi County Taiwan, ROC.
⁸ Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333 Taiwan, ROC.

Abstract

Background: Critical stroke causes high morbidity and mortality. We examined if variables in the early stage of critical stroke could predict in-hospital mortality.

Methods: We recruited 611 ischemic and 805 hemorrhagic stroke patients who were admitted within 24 h after the symptom onset. Data were analyzed with independent t test and Chi square test, and then with multivariate logistic regression analysis.

Results: In ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score (OR 1.08; 95 % CI 1.06-1.11; P < 0.01), white blood cell count (OR 1.11; 95 % CI 1.05-1.18; P < 0.01), systolic blood pressure (BP) (OR 0.49; 95 % CI 0.26-0.90; P = 0.02) and age (OR 1.03; 95 % CI 1.00-1.05; P = 0.03) were associated with in-hospital mortality. In hemorrhagic stroke, NIHSS score (OR 1.12; 95 % CI 1.09-1.14; P < 0.01), systolic BP (OR 0.25; 95 % CI 0.15-0.41; P < 0.01), heart disease (OR 1.94; 95 % CI 1.11-3.39; P = 0.02) and creatinine (OR 1.16; 95 % CI 1.01-1.34; P = 0.04) were related to in-hospital mortality. Nomograms using these significant predictors were constructed for easy and quick evaluation of in-hospital mortality.

Conclusion: Variables in acute stroke can predict in-hospital mortality and help decision-making in clinical practice using nomogram.

Keywords: Cerebrovascular disease; Intensive care unit; Mortality; Outcome; Risk prediction.