ArticleNeurocritical care2026
Dynamic GCS Trajectories and Mortality Risk in ICU Patients with Stroke: A Multicenter, Age-Stratified Study.
Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe purpose of this study was to determine whether dynamic Glasgow Coma Scale (GCS) trajectories are associated with mortality risk and provide incremental prognostic information beyond selected baseline clinical variables in intensive care unit (ICU)-admitted patients with non-traumatic stroke (NTS).
methodsIn this retrospective cohort study of 7876 patients from the MIMIC-IV, eICU, and NSICU databases, latent class growth modeling (LCGM) was used to identify GCS trajectories. The associations of trajectory groups and threshold-based GCS metrics with in-hospital mortality were evaluated using multivariable Cox regression. The incremental value of trajectories was assessed using variable sets selected by Boruta, least absolute shrinkage and selection operator (LASSO), and best subset selection (BSS).
resultsFour distinct GCS trajectories were identified: stable high (35.7%), rapid improvement (38.0%), persistent moderate (18.8%), and persistent low (7.5%). Compared with the stable high group, mortality risk increased stepwise in fully adjusted models, with HRs of 2.94 (95% CI 2.24-3.84), 8.11 (95% CI 6.18-10.66), and 17.72 (95% CI 13.30-23.59) for rapid improvement, persistent moderate, and persistent low, respectively. Threshold-based mean GCS AUC metrics were also associated with in-hospital mortality. A distinct gradual deterioration trajectory was observed in elderly patients (≥ 65 years). Adding GCS trajectories to the Boruta-selected baseline model improved predictive performance, increasing the AUC from 0.800 to 0.860, with an IDI of 0.085 and a continuous NRI of 0.283 (all P < 0.001).
conclusionsTrajectory-based and threshold-based longitudinal GCS assessments were strongly associated with in-hospital mortality in critically ill patients with NTS, supporting the value of dynamic GCS monitoring as a complementary tool for risk stratification in neurocritical care.
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