Predictors of ICU Admission Among Hispanic Patients with Anterior Stroke Beyond the Thrombolytic Window
Danny Japon1, Carlos Rodriguez Alarcon2, Juletsy Moreira Alcivar1, Luis Leyton Aguilar1, Presley Gruezo1, Linker Viñan Paucar1, Daniella Bustamante1, Ricardo Murguia Fuentes3
1Universidad Catolica de Santiago de Guayaquil, 2Neurology Department, University of Miami / Jackson Health System, 3University of Arkansas for Medical Sciences
Objective:

Identify baseline clinical and demographic factors that predict ICU admission among Hispanic patients with anterior ischemic stroke presenting outside the thrombolytic treatment window.

Background:
ICU admission after acute ischemic stroke is primarily determined by neurological deficits and underlying comorbidities. Hispanic populations remain underrepresented in studies evaluating ICU utilization, particularly among patients presenting beyond the thrombolytic window. Early identification of high-risk patients is essential to improve triage, accuracy, facilitate timely intervention, and optimize allocation of critical care resources.
Design/Methods:

We conducted a retrospective cohort study of Hispanic patients with de novo anterior ischemic stroke admitted to a stroke center in Ecuador. Baseline variables included age, sex, comorbidities (diabetes, hypertension, atrial fibrillation), and neurological deficits upon admission (aphasia, loss of consciousness, motor deficits, dysarthria). Stepwise multivariable logistic regression was performed to determine independent predictors of ICU admission, with variables entered sequentially.

Results:

Among 541 patients (mean age 71.6 ± 12.7 years; 53.4% male), 87 (16.1%) required ICU care, and overall in-hospital mortality was 25.7%. Loss of consciousness was observed in 55.1% of patients, aphasia in 32.7%, and atrial fibrillation in 11.5%. Independent predictors of ICU admission were loss of consciousness (OR=6.89, CI:3.43–13.85, p<0.001), aphasia (OR=3.17, CI:1.91–5.27, p<0.001), and atrial fibrillation (OR=2.58, 95% CI:1.35–4.93, p=0.004). Female sex was associated with a lower risk (OR=0.56, CI:0.34–0.95, p=0.030).

Conclusions:

In Hispanic patients with anterior ischemic stroke presenting outside the thrombolytic window, loss of consciousness, aphasia, and atrial fibrillation strongly predict ICU admission, while female sex confers a protective effect. These findings suggest that acute neurological impairment and pre-existing cardiac conditions are major determinants of ICU admission, independent of age and other comorbidities, highlighting factors that identify patients at the highest risk for critical care needs. Early recognition of these predictors may improve triage precision, optimize ICU resource utilization, and guide targeted interventions for high-risk Hispanic stroke patients.

10.1212/WNL.0000000000216488
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