Evaluation of the predictive value of mortality scoring systems for intubation need in ischemic stroke patients: A prospective study

Hasan Hüseyin Kozak; Ahmet Bugrul; Fatih Tol; Meliş Özkan

doi:10.55697/tnd.2024.202

Hasan Hüseyin Kozak¹, Ahmet Bugrul², Fatih Tol¹, Meliş Özkan¹

¹Department of Neurology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Türkiye
²Department of Neurology, Adıyaman Besni State Hospital, Adıyaman, Türkiye

Keywords: APACHE II, critical care, endotracheal intubation, prospective study, SAPS II, SOFA, stroke.

Abstract

Objectives: This study aimed to evaluate the prognostic accuracy of mortality scores for predicting the requirement of endotracheal intubation in ischemic stroke patients admitted to the intensive care unit.

Patients and methods: The prospective study examined 53 patients followed up in the stroke intensive care unit after ischemic stroke between June 2021 and April 2023. Patients were grouped as either intubated or not-intubated within the first seven days. Patients younger than 18 years of age and those with hemorrhagic stroke, late admission, insufficient data, or early discharge were excluded. The APACHE II (Acute Physiology and Chronic Health Evaluation), SAPS II (Simplified Acute Physiology Score), and SOFA (Sequential Organ Failure Assessment) scores measured at 24, 36, and 48 h were used to assess mortality rates. The National Institutes of Health Stroke Scale score was used to assess stroke severity, and the modified Rankin Scale was used to assess independent survival.

Results: Forty patients (19 males, 21 females; median age: 72 [64.2-79.5] years) were not intubated within the first seven days, while 13 (8 males, 5 females; median age: 76 [70.5-83.0] years) required intubation. There were no significant differences in demographic data or comorbidities between the two groups. Intubated patients exhibited increased levels of inflammatory markers and mortality scores at 24, 36, and 48 h following intubation. Only the APACHE II score at 24 h was identified as a significant independent risk factor for intubation (odds ratio=2.36, p=0.037), with an optimal threshold of 9.5 identified by receiver operating characteristic analysis (area under the curve=0.828).

Conclusion: The study identified that the APACHE II score, measured 24 h after admission, could reliably predict that ischemic stroke patients in the intensive care unit would require intubation within the first week. This discovery fills a significant gap, as present instruments estimate mortality but not the specific need for ventilation. These results emphasize the need for broader research into the development of improved predictive systems.

Cite this article as: Kozak HH, Bugrul A, Tol F, Özkan M. Evaluation of the predictive value of mortality scoring systems for intubation need in ischemic stroke patients: A prospective study. Turk J Neurol 2024;30(4):210-219. doi: 10.55697/tnd.2024.202.