Association of Socioeconomic Deprivation with 1-Year Functional Outcomes in Mechanically Ventilated Patients with Stroke.

BACKGROUND: The impact of socioeconomic deprivation on long-term prognosis of stroke patients requiring invasive mechanical ventilation in the intensive care unit (ICU) is unclear.

METHODS: We conducted an ancillary study of the SPICE prospective multicenter cohort conducted in 33 ICUs of the Greater Paris area between November 2017, and December 2018. Patients requiring mechanical ventilation upon ICU admission and within seven days of non-traumatic stroke were included. The primary endpoint was unfavorable functional outcome at one year (severe disability or death: modified Rankin Scale [mRS] score of 4-6). Deprivation at admission was assessed using the 2015 French Deprivation index (Fdep), based on patient addresses. The association of socioeconomic deprivation on outcome was evaluated using logistic regression, minimally adjusted for age and sex, then further adjusted for stroke type, center type, comorbidities, and severity at admission. Secondary endpoints included ICU stays, ICU and one-year survival, withholding/withdrawal life-sustaining therapies (WLST) decisions, and in survivors: quality of life (EQ-5D-3L), autonomy (Barthel Index), anxiety-depression (HADS), and post-discharge care pathways.

RESULTS: Among the 350 included patients, 129 (37%) were classified as deprived (Fdep > 0). Deprived patients were younger (59 vs 63 years, p = 0.02). Stroke type and severity at admission (NIHSS, Glasgow Coma Scale, non-neurological SOFA) did not differ between groups. At one-year, functional outcomes were similar (unfavorable outcome: 83/129 [64.3%] in deprived vs. 150/221 [67.9%] in non-deprived patients; minimally adjusted Odds Ratio [OR]: 0.99; 95% CI: 0.61-1.60, further adjusted OR: 0.98; 95% CI: 0,56-1.72). One-year survival was higher among deprived patients (minimally adjusted Hazard Ratio: 0.70; 95% CI: 0.51-0.96), a difference occurring mainly during the ICU stay. Deprivation was associated with longer ICU stays, but not with WLST decisions or outcomes in survivors.

CONCLUSIONS: Among stroke patients requiring mechanical ventilation in the ICU, socioeconomic deprivation was not associated with unfavorable one-year functional outcomes. These findings suggest that deprivation status, on its own, should not be considered as a determining prognostic factor in clinical decision-making in this specific population.