BMJ neurology open · 2026
Prognostic value of the SPICE score for 1-year functional outcomes in patients with acute stroke requiring mechanical ventilation.
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Mabiala Tharcisse, Mazighi Mikael, Collet Magalie, Degos Vincent, Duranteau Jacques, Grégoire Charles, Sharshar Tarek, Cortier David, Barhayiga Berthe, Bula Bula Médard, Mananga Lelo Gilbert, Timsit Jean-François, Sonneville Romain, de Montmollin Etienne, SPICE investigators group
Аннотация
BACKGROUND: Approximately 15 million people suffer from strokes each year and accurate prognostication is crucial for care management. This study evaluated the performance of the Stroke Prognosis in Intensive CarE (SPICE) score to predict functional outcomes at 1 year in patients who underwent mechanical ventilation following a stroke.
METHODS: Ancillary analysis of the SPICE prospective multicentre cohort study conducted from 2017 to 2019 in 33 intensive care units (ICUs) of the Greater Paris area. All patients requiring mechanical ventilation on ICU admission and within 7 days of a non-traumatic stroke were included. The primary outcome was poor functional prognosis at 1 year (severe disability or death: modified Rankin Scale score of 4-6). Variables independently associated with the outcome were used to compute a prognostic score (SPICE score).
RESULTS: Retained variables were stroke subtype, time between stroke diagnosis and initiation of mechanical ventilation, age, the Charlson Comorbidity Index and the Glasgow Coma Score (GCS) at ICU admission. The median SPICE score of the 364 patients of the cohort was 15 (IQR 11-19) and demonstrated acceptable predictive power (area under the receiver operating characteristic curve (AUROC) of 0.752) for poor outcome and outperformed GCS (AUROC 0.658) and Sequential Organ Failure Assessment (AUROC 0.655) scores. A threshold of >18 points on the SPICE score had a sensitivity of 35.7% and a specificity of 95% for poor outcome prediction, yielding a positive predictive value of 93.5% (95% CI 86.5% to 97.6%) and a positive likelihood ratio of 7.16 (95% CI 3.22 to 15.9).
CONCLUSIONS: For mechanically ventilated patients after a stroke, the SPICE score showed adequate predictive power for poor functional outcome at 1 year. Validation of the SPICE score in an external cohort is needed.
METHODS: Ancillary analysis of the SPICE prospective multicentre cohort study conducted from 2017 to 2019 in 33 intensive care units (ICUs) of the Greater Paris area. All patients requiring mechanical ventilation on ICU admission and within 7 days of a non-traumatic stroke were included. The primary outcome was poor functional prognosis at 1 year (severe disability or death: modified Rankin Scale score of 4-6). Variables independently associated with the outcome were used to compute a prognostic score (SPICE score).
RESULTS: Retained variables were stroke subtype, time between stroke diagnosis and initiation of mechanical ventilation, age, the Charlson Comorbidity Index and the Glasgow Coma Score (GCS) at ICU admission. The median SPICE score of the 364 patients of the cohort was 15 (IQR 11-19) and demonstrated acceptable predictive power (area under the receiver operating characteristic curve (AUROC) of 0.752) for poor outcome and outperformed GCS (AUROC 0.658) and Sequential Organ Failure Assessment (AUROC 0.655) scores. A threshold of >18 points on the SPICE score had a sensitivity of 35.7% and a specificity of 95% for poor outcome prediction, yielding a positive predictive value of 93.5% (95% CI 86.5% to 97.6%) and a positive likelihood ratio of 7.16 (95% CI 3.22 to 15.9).
CONCLUSIONS: For mechanically ventilated patients after a stroke, the SPICE score showed adequate predictive power for poor functional outcome at 1 year. Validation of the SPICE score in an external cohort is needed.