Epidemiology and disease burden of patients requiring neurocritical care: a Brazilian multicentre cohort study
Authors: Réa-Neto Álvaro , Bernardelli Rafaella Stradiotto , de Oliveira Mirella Cristine , David-João Paula Geraldes , Kozesinski-Nakatani Amanda Christina , Falcão Antônio Luís Eiras , Kurtz Pedro Martins Pereira , Teive Hélio Afonso Ghizoni ,   Neurocritical Brazil Study group, Caltabeloti Fabíola Prior , Soriano Salomon , Veiga Viviane Cordeiro , Bozza Fernando Augusto , Tannous Luana Alves , Gasparetto Juliano , Alves Fernanda Sampaio , Brasil José Arthur Santos , Rocha Glécia Carla , Junior Jarbas Motta , Câmara Bruna Martins Dzivielevski , Figueiredo Livia Rodrigues , Oliveira Janaína , Vianna William Nascimento , Iglesias Diogo Roberto Lorenzo , Deucher Rafael Alexandre de Oliveira , Martins Gloria , Lopes Marcel Resende , de Carvalho Frederico Bruzzi , Paranhos Jorge Luiz da Rocha , de Andrade e Silva Ulysses Vasconcellos , Py Marco Oliveira , Reese Fernanda Baeumle , Knibel Marcos Freitas , Patriota Gustavo Cartaxo , Lobo Suzana Margareth Ajeje , Guimarães Junior Mario Roberto Rezende , Neves Luciana de Oliveira , Fagundes Antônio Aurélio , Serpa Neto Ary , Baptista Walter Carlos Girardelli , Grion Cintia Magalhães Carvalho , Duarte Péricles Almeida Delfino , Branco Bruno , Salgado Luísa da Silva André , Costa Nívea Melo de Souza , Pompermayer Danilo Bastos , Kaled Anna Flavia , Brum Rafael , de Souza Alessandro Rocha Milan , Fuck Jackson Erasmo , Piras Claudio 
Published: October 2023

Acute neurological emergencies are highly prevalent in intensive care units (ICUs) and impose a substantial burden on patients. This study aims to describe the epidemiology of patients requiring neurocritical care in Brazil, and their differences based on primary acute neurological diagnoses and to identify predictors of mortality and unfavourable outcomes, along with the disease burden of each condition at intensive care unit admission. This prospective cohort study included patients requiring neurocritical care admitted to 36 ICUs in four Brazilian regions who were followed for 30 days or until ICU discharge (Aug-Sep in 2018, 1 month). Of 4245 patients admitted to the participating ICUs, 1194 (28.1%) were patients with acute neurological disorders requiring neurocritical care and were included. Patients requiring neurocritical care had a mean mortality rate 1.7 times higher than ICU patients not requiring neurocritical care (17.21% versus 10.1%, respectively). Older age, emergency admission, higher number of potential secondary injuries, and worse APACHE II, SAPS III, SOFA, and Glasgow coma scale scores on ICU admission are independent predictors of mortality and poor outcome among patients with acute neurological diagnoses. The estimated total DALYs were 4482.94 in the overall cohort, and the diagnosis with the highest DALYs was traumatic brain injury (1634.42). Clinical, epidemiological, treatment, and ICU outcome characteristics vary according to the primary neurologic diagnosis. Advanced age, a lower GCS score and a higher number of potential secondary injuries are independent predictors of mortality and unfavourable outcomes in patients requiring neurocritical care. The findings of this study are essential to guide education policies, prevention, and treatment of severe acute neurocritical diseases.