Clinical and epidemiological profile of patients with neurocritical conditions admitted to intensive care units: a cohort study.

OBJECTIVE

To describe the epidemiology of patients requiring neurocritical care in intensive care units in Curitiba, Brazil, examine differences based on primary acute neurological diagnoses, and identify predictors of mortality and unfavorable intensive care unit outcomes.

METHODS

This was a retrospective cohort study involving patients aged 18 years or older who were admitted to the intensive care units of seven hospitals from January 2017 to December 2022. Patients admitted for primary neurological diagnoses were compared with those admitted for other causes. Cox regression models were used to assess factors associated with mortality and unfavorable outcomes (modified Rankin Scale scores of 4-6) in neurocritical care.

RESULTS

A total of 62,101 patients were included, with 10,884 admitted for neurological reasons. Compared with non-neurological patients, those with neurological diagnoses were significantly older and had lower levels of consciousness upon admission but lower APACHE II and SOFA scores, shorter intensive care unit stays, and lower mortality rates. Despite this, surviving patients admitted with neurological diagnoses experienced greater functional limitations. The leading causes of neurological admission included postoperative monitoring of intracranial surgery (32.6%), ischemic stroke (19%), traumatic brain injury (17%), seizure (7.1%), hemorrhagic stroke (6.5%), subarachnoid hemorrhage (4.5%), encephalopathy (4.2%), spinal cord conditions (3.8%), central nervous system infection (1.8%), neuromuscular diseases (0.8%), and other conditions (2.5%). Older age, use of vasoactive drugs upon admission, creatinine level ≥ 1.5mg/dL, lower level of consciousness within the first 24 hours, and primary neurological diagnoses of ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, encephalopathy, and other conditions emerged as independent predictors of an increased hazard ratio of death and an unfavorable intensive care unit outcome.

CONCLUSION

Patients admitted to intensive care units due to neurological disorders had lower mortality rates but developed higher degrees of functional dependence. Among neurocritically ill patients, those requiring vasoactive drugs upon admission, those with elevated creatinine levels (≥ 1.5mg/dL), and those admitted due to ischemic stroke, hemorrhagic stroke, or subarachnoid hemorrhage had a greater risk of death and unfavorable outcomes.