Risk Factors for Mortality in Patients with Stroke Admitted to Invasive Unit Care or Mechanical Ventilation or Critical Care: A Systematic Review and Meta-Analysis
Amr Elrosasy1, Ibrahim Serag2, Obai Yousef3, Khalid Sarhan2, Moaz Elsayed Abouelmagd3, Munzer Naima4, Alshaimaa Gala5, Linda Alkassas3, Ahmed Negida6
1Faculty of Medicine, Cairo University, Cairo, Egypt, 2Faculty of Medicine, Mansoura University, 3Faculty of Medicine, Tartous University, Tartous, Syria, 4University of Aleppo, Faculty of Medicine, Aleppo, Syria, 5Faculty of Medicine Fayoum University, Fayoum, Egypt, 6Virginia Commonwealth University
Objective:
This systematic review and meta-analysis aimed to synthesize existing evidence on the risk factors associated with mortality in stroke patients admitted to ICUs and critical care units.
Background:
Stroke is a leading cause of morbidity and mortality worldwide, and patients admitted to intensive care units (ICUs) who require mechanical ventilation face an even higher risk of adverse outcomes, including increased mortality. Effective management in ICUs is crucial to improve patient outcomes.
Design/Methods:
A comprehensive search was conducted across four databases: PubMed, Web of Science, Scopus, and Embase, up to July 9, 2024. Studies were included if they evaluated mortality risk factors in adult stroke patients admitted to ICUs. Data were extracted and analyzed using a random-effects model to account for heterogeneity. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for various risk factors
Results:
Eighteen studies involving 20,442 patients were included in the meta-analysis. Age was significantly associated with increased mortality (OR=1.02; 95% CI: 1.01, 1.03). Lower Glasgow Coma Scale (GCS) scores were linked to higher mortality (OR=0.92; 95% CI: 0.80, 1.04), though not statistically significant. Higher National Institutes of Health Stroke Scale (NIHSS) scores showed a significant association with increased mortality (OR=1.07; 95% CI: 1.03, 1.11). Mechanical ventilation was associated with a higher risk of death (OR=1.61; 95% CI: 1.33, 1.94). Comorbidities such as diabetes (OR=1.24; 95% CI: 1.04, 1.47) and atrial fibrillation (OR=1.39; 95% CI: 1.10, 1.76) significantly contributed to mortality risk, while a higher body mass index (BMI) was associated with a reduced risk of mortality (OR=0.95; 95% CI: 0.92, 0.98).
Conclusions:
This study highlights the critical importance of early identification and targeted management of high-risk stroke patients in ICU settings. Age, neurological status, respiratory support needs, and specific comorbidities are key factors that clinicians should consider improving survival outcomes.
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