Prognostic value of the SPICE score for 1-year functional outcomes in patients with acute stroke requiring mechanical ventilation
Tharcisse Mabiala, Mikael Mazighi, Magalie Collet, Vincent Degos, Jacques Duranteau, Charles Grégoire, Tarek Sharshar, David Cortier, Berthe Barhayiga, Médard Bula bula, Gilbert Mananga Lelo, Jean-François Timsit, Romain Sonneville, Etienne de MontmollinBackground
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.