Predictors of mortality in stroke patients admitted to an intensive care unit

Objective: Improved pathophysiologic insight and prognostic information reg arding in-hospital risk of mortality among stroke patients admitted to an i ntensive care unit. Design: Retrospective analysis. Setting: Neurology/neurosurgery intensive care unit in a tertiary care univ ersity medical center. Patients: A total of 63 consecutive ischemic stroke patients. Interventions: Patients were classified according to in-hospital mortality. Charts were reviewed to retrospectively generate an admitting Acute Physio logy and Chronic Health Evaluation (APACHE) II score. The APACHE II score a nd its individual components were assessed for predicting subsequent death. Measurements and Main Results: Of 63 patients, 13 died and 50 survived to e ither discharge or surgical intervention. The mean admitting APACHE II scor e of survivors (6.9) was lower than that of patients who died (17.2; p < .0 001). None of the 33 patients with a score <9 died, compared with 43% of th ose with a score greater than or equal to 9. A score greater than or equal to 18 was uniformly associated with fatal outcome (n = 8). Univariate analy sis identified APACHE II total score, Glasgow Coma Scale score, temperature , pH, and white blood cell count as significant predictors of death. Among multivariate logistic regression models examining the components of the APA CHE II score, the model containing white blood cells, temperature, and crea tinine best predicted death. Conclusions: Several features of the APACHE II score are associated with ri sk of death in this patient population. The findings suggest particular phy siologic derangements that are associated with, and may contribute to, incr eased mortality in critically ill patients with acute ischemic stroke.