Tongyoo S, Viarasilpa T, Vichutavate M, Permpikul C
Faculty of Medicine, Mahidol University; Siriraj Hospital, Bangkoknoi, Bangkok, Thailand.
South Afr J Crit Care. 2023 Apr 12;39(1). doi: 10.7196/SAJCC.2023.v39i1.558. eCollection 2023.
In-hospital stroke is a serious event, associated with poor outcomes and high mortality. However, identifying signs of stroke may be more difficult in critically ill patients.
This study investigated the prevalence and independent predictors of in-hospital stroke among patients with acute alteration of consciousness in the medical intensive care unit (MICU) who underwent subsequent brain computed tomography (CT).
This retrospective study enrolled eligible patients during the period 2007 - 2017. The alterations researched were radiologically confirmed acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH).
Of 4 360 patients, 113 underwent brain CT. Among these, 31% had AIS, while 15% had ICH. They had higher diastolic blood pressures and arterial pH than non-stroke patients. ICH patients had higher mean (standard deviation (SD) systolic blood pressures (152 (48) v. 129 (25) mmHg; p=0.01), lower mean (SD) Glasgow Coma Scale scores (4 (3) v. 7 (4); p=0.004), and more pupillary abnormalities (75% v. 9%; p<0.001) than AIS patients. AIS patients were older (65 (18) v. 57 (18) years; p=0.03), had more hypertension (60% v. 39%; p=0.04), and more commonly presented with the Babinski sign (26% v. 9%; p=0.04). Multivariate analysis found that pupillary abnormalities independently predicted ICH (adjusted odds ratio (aOR) 26.9; 95% CI 3.7 - 196.3; p=0.001). The Babinski sign (aOR 5.1; 95% CI 1.1 - 23.5; p=0.04) and alkalaemia (arterial pH >7.4; aOR 3.6; 95% CI 1.0 - 12.3; p=0.05) independently predicted AIS.
Forty-six percent of the cohort had ICH or AIS. Both conditions had high mortality. The presence of pupillary abnormalities predicts ICH, whereas the Babinski sign and alkalaemia predict AIS.
The present study reports that almost half (46%) of critically ill patients with alterations of consciousness had an acute stroke. Of these, two-thirds had an acute ischaemic stroke (AIS), and one-third had an intracranial haemorrhage (ICH). Multivariate analysis revealed that a pupillary abnormality was a predictor for ICH and the Babinski sign was identified as a predictor of AIS.
院内卒中是一种严重事件，与不良预后和高死亡率相关。然而，在危重症患者中识别卒中迹象可能更困难。
本研究调查了医学重症监护病房（MICU）中意识急性改变且随后接受脑部计算机断层扫描（CT）的患者院内卒中的患病率及独立预测因素。
这项回顾性研究纳入了2007年至2017年期间符合条件的患者。所研究的病变为经放射学证实的急性缺血性卒中（AIS）和脑出血（ICH）。
4360例患者中，113例接受了脑部CT检查。其中，31%患有AIS，15%患有ICH。他们的舒张压和动脉pH值高于非卒中患者。ICH患者的平均（标准差（SD））收缩压更高（152（48）对129（25）mmHg；p = 0.01），平均（SD）格拉斯哥昏迷量表评分更低（4（3）对7（4）；p = 0.004），瞳孔异常更多（75%对9%；p < 0.001）。与AIS患者相比，AIS患者年龄更大（65（18）对57（18）岁；p = 0.03），高血压更多（60%对39%；p = 0.04），更常出现巴宾斯基征（26%对9%；p = 0.04）。多因素分析发现瞳孔异常可独立预测ICH（调整优势比（aOR）26.9；95%置信区间3.7 - 196.3；p = 0.001）。巴宾斯基征（aOR 5.1；95%置信区间1.1 - 23.5；p = 0.04）和碱血症（动脉pH > 7.4；aOR 3.6；95%置信区间1.0 - 12.3；p = 0.05）可独立预测AIS。
该队列中46%的患者患有ICH或AIS。两种情况的死亡率都很高。瞳孔异常的存在可预测ICH；而巴宾斯基征和碱血症可预测AIS。
本研究报告称，近一半（46%）意识改变的危重症患者发生了急性卒中。其中，三分之二为急性缺血性卒中（AIS），三分之一为颅内出血（ICH）。多因素分析显示，瞳孔异常是ICH的预测因素，巴宾斯基征被确定为AIS的预测因素。
