SPICE Score Predicts Long-Term Outcomes After Stroke

A NEW prognostic scoring system has demonstrated promising accuracy in predicting long-term disability and mortality among patients with acute stroke requiring mechanical ventilation, according to findings from a multicentre study.

The Stroke Prognosis in Intensive CarE (SPICE) score outperformed commonly used intensive care assessment tools in predicting severe disability or death at 1 year, potentially supporting more informed clinical decision-making and discussions with patients’ families.

Predicting Long-Term Outcomes After Severe Stroke

Approximately 15 million people experience a stroke worldwide each year, with severe cases frequently requiring intensive care and mechanical ventilation.

Predicting long-term functional outcomes in these critically ill patients remains challenging, particularly when neurological assessments are complicated by sedation, impaired consciousness, or other critical care interventions.

Researchers evaluated the prognostic performance of the SPICE score using data from a prospective multicentre cohort study conducted between 2017 and 2019 across 33 intensive care units in the Greater Paris area, France.

The analysis included 364 patients who required mechanical ventilation upon intensive care admission within 7 days of a non-traumatic stroke.

The primary outcome was poor functional status at 1 year, defined as severe disability or death, corresponding to a modified Rankin Scale score of 4–6.

SPICE Score Outperforms Conventional Assessment Tools

Researchers identified five variables independently associated with poor functional outcomes: stroke subtype, time between stroke diagnosis and initiation of mechanical ventilation, age, Charlson Comorbidity Index, and Glasgow Coma Scale (GCS) score at intensive care admission.

These variables were incorporated into the SPICE score, which had a median value of 15 across the cohort, with an interquartile range of 11–19.

The score demonstrated acceptable discrimination for predicting severe disability or death at 1 year, achieving an area under the receiver operating characteristic curve (AUROC) of 0.752.

This exceeded the predictive performance of the GCS alone, which achieved an AUROC of 0.658, and the Sequential Organ Failure Assessment (SOFA) score, which achieved an AUROC of 0.655.

The findings suggest that combining neurological, clinical, and comorbidity-related factors may provide a more comprehensive assessment of long-term prognosis than relying on individual severity measures.

High SPICE Scores Identify Patients at Greater Risk

A SPICE score threshold above 18 demonstrated particularly high specificity for predicting poor functional outcomes.

At this threshold, specificity reached 95.0%, while sensitivity was 35.7%, indicating that the score identified a relatively small proportion of patients who ultimately experienced severe disability or death, but produced comparatively few false-positive predictions.

The positive predictive value was 93.5% (95% CI 86.5–97.6%), while the positive likelihood ratio was 7.16 (95% CI 3.22–15.9).

These results suggest that patients with scores above 18 were highly likely to experience poor outcomes within the study cohort. However, the relatively low sensitivity means that many patients with unfavourable outcomes would not be identified using this threshold alone.

The researchers concluded that the SPICE score could provide a useful additional tool for prognostic assessment in mechanically ventilated stroke patients.

Nevertheless, external validation in independent populations is required before the score can be recommended for routine clinical use. Prognostic estimates should also be interpreted alongside individual patient characteristics and clinical judgement, rather than used in isolation to guide treatment decisions.

Reference

Mabiala T, Mazighi M, Collet M, Degos V, Duranteau J, Grégoire C, et al. Prognostic value of the SPICE score for 1-year functional outcomes in patients with acute stroke requiring mechanical ventilation. BMJ Neurology Open. 2026;8:e001709. https://doi.org/10.1136/bmjno-2026-001709