Prediction in patients who had a stroke and needed care at an intensive care unit concerning their changes of survival and the capacity to function in daily life after their illness

ISRCTN	ISRCTN13328713
DOI	https://doi.org/10.1186/ISRCTN13328713
Secondary identifying numbers	Retrospective UCLH Stroke Intensive care audit

Submission date: 12/02/2017
Registration date: 18/03/2017
Last edited: 23/01/2019

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Circulatory System

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Plain English summary of protocol

Background and study aims
A stroke is a serious medical condition that occurs when the blood supply to part of the brain is cut off. Stroke is a major healthcare issue worldwide. Mortality (death rate) from stroke has declined over time, but stroke is still responsible for one of every twenty deaths in the United States. Patients with severe stroke may need treatment in an intensive care unit (ICU). The long-term consequences of stroke have been investigated thoroughly, but much less is known about those patients who need to be admitted to the ICU. The aim of this study is to find the clinical parameters, measured when these stroke patients are admitted to an ICU, that can predict the patient’s long-term survival as well as their capacity to function in daily life after their illness.

Who can participate?
Stroke patients aged 18 or older, admitted via the Emergency Department (ED) to either the general or neurosurgical ICU of one of the University College London Hospitals (UCLH) in North Central London between February 2010 and May 2012

What does the study involve?
Participants are monitored for 4-6 years to see if they are still alive and if not, when they died. The participant’s capacity to function in daily life is also recorded. These values are measured at two moments: when the patient leaves the hospital and after one year at their follow-up check appointment. These data are used to find out which clinical parameters predict whether patients are likely to survive a stroke, their ability to function in daily life one year after their illness, and how they progress in this ability during the first year.

What are the possible benefits and risks of participating?
There are no direct benefits and risks to participants because this study only uses patient data obtained from databases. Future stroke patients could benefit from this study, because the results may help identify critical stroke patients who are at increased risk of death or poor functional outcome.

Where is the study run from?
University College London Hospitals NHS Foundation Trust (UK)

When is the study starting and how long is it expected to run for?
February 2010 to February 2016

Who is funding the study?
Investigator initiated and funded

Who is the main contact?
1. Miss Mariel van Valburg (scientific)
2. Dr Bart Geerts (scientific)

Contact information

Miss Mariel van Valburg
Scientific

Department of Anaesthesiology
University Medical Centre Utrecht
PO Box 85500, Mail stop Q.04.2.313
Utrecht
3508 GA
Netherlands

ORCID ID	0000-0003-1242-994X

Dr Bart Geerts
Scientific

Department of Anaesthesiology
Academic Medical Centre Amsterdam
Meibergdreef 9
Amsterdam
1015 AZ
Netherlands

Study information

Study design	Single-centre retrospective observational cohort study
Primary study design	Observational
Secondary study design	Cohort study
Study setting(s)	Hospital
Study type	Other
Participant information sheet	No participant information sheet available
Scientific title	Clinical predictors of short-term and long-term survival and functional outcome of ICU-admitted stroke patients
Study objectives	This long-term follow-up study is conducted to determine the predictive value of common-used clinical parameters upon ICU admission for long-term all-cause mortality and functional outcome of adult ischaemic and intracerebral haemorrhagic stroke patients admitted to the ICU.
Ethics approval(s)	Demographic and clinical data were obtained as part of an audit of standard care. All data were only acquired from the national, trust and hospital databases. Therefore all authors can confirm that ethics approval was not needed for this study.
Health condition(s) or problem(s) studied	Stroke; ischaemic and intracerebral haemorrhagic cerebrovascular accident (CVA)
Intervention	Demographic and clinical data were obtained from the national, trust and hospital databases. Patients were selected if they were admitted to one of our four ICUs between February 2010 and May 2012 with a clinical diagnosis of acute ischaemic or intracerebral haemorrhagic stroke. Surviving patients were censored on February 20, 2016. Prognostic factors for long-term all-cause post-stroke mortality will be determined by univariable and multivariable Cox proportional hazards regression analysis with log minus log plots to confirm proportionality of hazards assumption over time. Prognostic factors for good functional outcome and improved functional status will be determined with binary logistic regression. Model development will be performed on a multiple imputed dataset with variable exclusion in a backward stepwise selection procedure set to the lowest p value in the model.
Intervention type	Other
Primary outcome measure	All-cause mortality after ischaemic or intracerebral haemorrhagic stroke. The follow-up timepoints lie between 4 and 6 years (depending on when the patient suffered a critical stroke) or on the moment the patient died.
Secondary outcome measures	Functional outcome, measured using the modified Rankin scale at hospital discharge and at one year follow-up check appointment and recorded by the patient’s primary treating physician. The original data using this ordinal scale will be dichotomised for analysis. Good functional outcome is defined as independent functional status (mRS 0-2) versus poor functional outcome, defined as dependent functional status or dead (mRS 3-6). Furthermore, transition in mRS will be taken into account, defined as improved functional status (mRS even or increased between discharge and after one year) versus declined functional status (mRS decreased between discharge and after one year).
Overall study start date	01/02/2010
Completion date	20/02/2016

Eligibility

Participant type(s)	Patient
Age group	Adult
Lower age limit	18 Years
Sex	Both
Target number of participants	100
Key inclusion criteria	1. Adult patients (aged 18 years or older) admitted via the Emergency Department (ED) to either the general or neurosurgical ICU of one of the University College London Hospitals (UCLH) in North Central London between February 2010 and May 2012 2. Clinical diagnosis of acute ischaemic or intracerebral haemorrhagic stroke, confirmed by non-contrast cranial CT scan
Key exclusion criteria	1. Patients with a subarachnoid or subdural bleeding 2. Patients with a known intra-cerebral or intracerebellar tumour 3. Patients who suffered an in-hospital stroke 4. Patients who were referred from another ICU for the same diagnosis
Date of first enrolment	01/02/2010
Date of final enrolment	31/05/2012

Locations

Countries of recruitment

England
United Kingdom

Study participating centre

University College London Hospitals NHS Foundation Trust

235 Euston Road
London
NW1 2BU
United Kingdom

Sponsor information

University College London Hospital NHS Foundation Trust
Hospital/treatment centre

235 Euston Road
London
NW1 2BU
England
United Kingdom

Website	https://www.uclh.nhs.uk/Pages/Home.aspx
"ROR"	https://ror.org/042fqyp44

Funders

Funder type

Hospital/treatment centre

University College London Hospital NHS Foundation Trust

No information available

Results and Publications

Intention to publish date	01/05/2017
Individual participant data (IPD) Intention to share	Yes
IPD sharing plan summary	Available on request
Publication and dissemination plan	Planned publication in a high-impact peer reviewed journal aiming within the first half year of 2017.
IPD sharing plan	The datasets generated during and/or analysed during the current study are/will be available upon request from Miss Mariel van Valburg.

Study outputs

Output type	Details	Date created	Date added	Peer reviewed?	Patient-facing?
Results article	results	01/07/2018	23/01/2019	Yes	No

Editorial Notes

23/01/2019: Publication reference added