Comparing withdrawal and not withdrawal of life-sustaining treatment among patients who died from stroke

Abstract

Eirik Helvig,1 Lars Thomassen,2 Ulrike Waje-Andreassen,2 Halvor Naess3 1Department of Neurology, Haukeland University Hospital, Jonas Liesgt, Bergen, 2Institute of Clinical Medicine, University of Bergen, Bergen, 3Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, NorwayBackground: In severe stroke, a decision to withdraw life-sustaining treatment is sometimes made in cooperation with the family. The aim of this study was to study the time from withdrawing life-sustaining treatment to death in patients with severe ischemic or hemorrhagic stroke.Methods: In total, 2,506 patients with stroke admitted to Haukeland University Hospital between 2006 and 2011 were prospectively registered in the Bergen NORSTROKE database. Risk factors, stroke severity, etiology, and blood analyses were registered. Retrospectively, the patients' records were examined to determine the number of days from withdrawing all life-sustaining treatment to death in patients who died from severe stroke during the hospital stay.Results: Life-sustaining treatment was withheld in 50 patients with severe stroke. Median time to death after withdrawing life-sustaining treatment was 4 days, and a quarter lived at least 1 week (range =1–11 days). Cox regression analyses showed that short time from withdrawing life-sustaining treatment to death was associated with high age (Hazard ratio [HR] =1.05, P=0.07), male sex (HR =2.9, P=0.01), high C-reactive protein on admission (HR =1.01, P=0.001), and hemorrhagic stroke (versus ischemic stroke, HR =1.5, P=0.03).Conclusion: One week after withdrawing life-sustaining treatment, a quarter of our patients with severe stroke remained alive. Short time to death was associated with high age, male sex, hemorrhagic stroke, and high C-reactive protein on admittance. Keywords: stroke, withdrawal of life-sustaining treatment, prognosis