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Intensive Care Unit Admission for Patients in the INTERACT2 ICH Blood Pressure Treatment Trial: Characteristics, Predictors, and Outcomes

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Abstract

Background

Wide variation exists in criteria for accessing intensive care unit (ICU) facilities for managing patients with critical illnesses such as acute intracerebral hemorrhage (ICH). We aimed to determine the predictors of admission, length of stay, and outcome for ICU among participants of the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).

Methods

INTERACT2 was an international, open, blinded endpoint, randomized controlled trial of 2839 ICH patients (<6 h) and elevated systolic blood pressure (SBP) allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) BP-lowering treatment. The primary outcome was death or major disability, defined by modified Rankin scale scores 3–6 at 90 days. Logistic regression and propensity score analyses were used to determine independent associations.

Main Results

Predictors of ICU admission included younger age, recruitment in China, prior ischemic/undetermined stroke, high SBP, severe stroke [National Institute of Health stroke scale (NIHSS) score ≥15], large ICH volume (≥15 mL), intraventricular hemorrhage (IVH) extension, early neurological deterioration, intubation and surgery. Determinants of prolonged ICU stay (≥5 days) were prior antihypertensive use, NIHSS ≥15, large ICH volume, lobar ICH location, IVH, early neurological deterioration, intubation and surgery. ICU admission was associated with higher-risk major disability at 90-day assessment compared to those without ICU admission.

Conclusions

This study presents prognostic variables for ICU management and outcome of ICH patients included in a large international cohort. These data may assist in the selection and counseling of patients and families concerning ICU admission.

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Funding

National Health and Medical Research Council of Australia (Program Grant 571281 and Project Grants 512402 and 1004170).

Authors’ contributions

KEW and PMV made substantial contribution to conception, design, acquisition and interpretation of data, drafted manuscript, and gave final approval of version to be published and agreement to be accountable for all aspects of the work; XW made substantial contribution to data analysis, drafted manuscript, and gave final approval of version to be published and agreement to be accountable for all aspects of the work; CA and TR made substantial contribution to conception, design, acquisition, analysis and interpretation of data, critical input to the final version to be published and gave final approval of version to be published and agreement to be accountable for all aspects of the work; AAR, HA, PML, RIL, and JC made substantial contribution to acquisition of data and gave critical input to the final version to be published.

Author information

Authors and Affiliations

  1. Neurointensive Care Unit, Martin-Luther-University Halle-Wittenberg, Halle, Germany

    Katja E. Wartenberg

  2. Neurological and Mental Health Division, The George Institute for Global Health, University of Sydney, and Neurology Department, Royal Prince Alfred Hospital, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia

    Xia Wang, Paula Muñoz-Venturelli & Craig S. Anderson

  3. Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile

    Paula Muñoz-Venturelli & Pablo M. Lavados

  4. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Alejandro A. Rabinstein

  5. Universidad de Chile, Santiago, Chile

    Pablo M. Lavados

  6. The George Institute, Peking University Health Sciences Center, Beijing, China

    Craig S. Anderson

  7. Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, UK

    Thompson Robinson

Authors
  1. Katja E. Wartenberg
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  2. Xia Wang
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  3. Paula Muñoz-Venturelli
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  4. Alejandro A. Rabinstein
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  6. Craig S. Anderson
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  7. Thompson Robinson
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Consortia

For the INTERACT Investigators

Corresponding author

Correspondence to Craig S. Anderson.

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Conflicts of interest

Dr. Anderson reports grants from National Health and Medical Research Council (NHMRC) of Australia, during the conduct of the study; personal fees from Takeda China, personal fees from Astra Zeneca, personal fees from Medtronic, outside the submitted work; and Member of the Editorial Committee of the journals Stroke, Cerebrovascular Diseases and International Journal of Stroke. Other authors have no conflicts to declare.

Additional information

Katja E. Wartenberg and Xia Wang are joint primary authors.

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Wartenberg, K.E., Wang, X., Muñoz-Venturelli, P. et al. Intensive Care Unit Admission for Patients in the INTERACT2 ICH Blood Pressure Treatment Trial: Characteristics, Predictors, and Outcomes. Neurocrit Care 26, 371–378 (2017). https://doi.org/10.1007/s12028-016-0365-4

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  • DOI: https://doi.org/10.1007/s12028-016-0365-4

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