TY - JOUR
T1 - Association between critical care admission and 6-month functional outcome after spontaneous intracerebral haemorrhage
AU - on behalf of the CROMIS-2 Collaborators
AU - Mc Lernon, Siobhan
AU - Schwarz, Ghil
AU - Wilson, Duncan
AU - Ambler, Gareth
AU - Goodwin, Russell
AU - Shakeshaft, Clare
AU - Cohen, Hannah
AU - Yousry, Tarek
AU - Salman, Rustam Al Shahi
AU - Lip, Gregory Y.H.
AU - Houlden, Henry
AU - Brown, Martin M.
AU - Muir, Keith W.
AU - Jäger, Hans Rolf
AU - Terry, Louise
AU - Werring, David J.
N1 - Funding Information:
The CROMIS-2 study was funded by the Stroke Association and the British Heart Foundation. Dr. Ambler receives funding from the National Institute For Health Research University College London Hospitals Biomedical Research Centre. Dr. Werring receives research support from the Stroke Association , the British Heart Foundation , and the Rosetrees Trust . Siobhan McLernon receives funding from London South Bank University , School of Health and Social Care .
Publisher Copyright:
© 2020 Elsevier B.V.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11/15
Y1 - 2020/11/15
N2 - Background: There is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH). Purpose: We investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome. 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: 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: 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.
AB - Background: There is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH). Purpose: We investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome. 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: 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: 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.
KW - Critical care
KW - Intensive care
KW - Modified Rankin scale (mRS) functional outcome
KW - Spontaneous intracerebral haemorrhage
UR - http://www.scopus.com/inward/record.url?scp=85091258616&partnerID=8YFLogxK
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U2 - 10.1016/j.jns.2020.117141
DO - 10.1016/j.jns.2020.117141
M3 - Article
C2 - 32977232
AN - SCOPUS:85091258616
VL - 418
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
SN - 0022-510X
M1 - 117141
ER -