Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage

Abstract

Background:Intracerebral hemorrhage (ICH) is a life threatening entity, and an early outcome assessment is mandatory for optimizing therapeutic efforts.Methods:We retrospectively analyzed data from 342 patients with spontaneous primary ICH to evaluate possible predictors of 30-day mortality considering clinical, radiological, and therapeutical parameters. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study.Results:From 342 patients (mean age: 67 years, mean Glasgow Coma Scale [GCS] on admission: 9, mean ICH volume: 62.19 ml, most common hematoma location: basal ganglia [43.9%]), 102 received surgical and 240 conservative treatment. The 30-day mortality was 25.15%. In a multivariate analysis, GCS (Odds ratio [OR] =0.726, 95% confidence interval [CI] =0.661–0.796, P < 0.001), bleeding volume (OR = 1.012 per ml, 95% CI = 1.007 – 1.017, P < 0.001), and infratentorial hematoma location (OR = 5.381, 95% CI = 2.166-13.356, P = 0.009) were significant predictors for the 30-day mortality. After receiver operating characteristics analysis, we defined a “high-risk group” for an unfavorable short-term outcome with GCS <11 and ICH volume >32 ml supratentorially or 21 ml infratentorially. Using Pearson correlation, we found a correlation of 0.986 between ICH score and 30-day mortality (P < 0.001), 0.853 between FUNC score and 30-day mortality (P = 0.001), and 0.924 between ICH-GS and 30-day mortality (P = 0.001).Conclusions:GCS score on admission together with the baseline volume and localization of the hemorrhage are strong predictors for 30-day mortality in patients with spontaneous primary intracerebral hemorrhage, and by relying on them it is possible to identify high-risk patients with poor short-term outcome. The ICH score and the ICH-GS accurately predict the 30-day mortality.

Functional outcome and survival following spontaneous intracerebral hemorrhage: A retrospective population‐based study

“…The mortality rate in the present study was 22.1% the first week, 39.2% at 3 months, and 44.9% at 12 months, which is in general agreement with data from previous studies, reporting mortality rates from 25%–50% (Flaherty et al, ; Gonzalez‐Perez, Gaist, Wallander, McFeat, & Garcia‐Rodriguez, ; Qureshi et al, ; Sacco, Marini, Toni, Olivieri, & Carolei, ). At 3 months, only 15.7% of the patients had a favorable outcome (mRS <2), correlating well with studies presenting functional independency rates from 12% to 39% (Flemming et al, ; Safatli et al, ; van Asch et al, ). However, it is difficult to compare results across studies due to variation in inclusion criteria, outcome measures, and statistical analyses.…”

“…Several grading systems for predicting ICH mortality exist, using different clinical and diagnostic imaging characteristics (Hemphill, Bonovich, Besmertis, Manley, & Johnston, ; Rost et al, ; Ruiz‐Sandoval, Chiquete, Romero‐Vargas, Padilla‐Martinez, & Gonzalez‐Cornejo, ). Level of consciousness and baseline volume of parenchymal hemorrhage have been shown to be independent predictors of poor outcome (Davis et al, ; Flemming et al, ; Nilsson, Lindgren, Brandt, & Saveland, ; Safatli et al, ), whereas the impact of intraventricular extension and hematoma location remains more uncertain (Bhatia et al, ; Flemming et al, ). The goal of this population‐based study was to investigate functional outcome in patients with ICH in a high resource setting.…”

Evaluation of Intracerebral Hemorrhage Functional Outcome Score informativeness for identification of short-term vital outcome in patients with spontaneous supratentorial intracerebral haemorrhage

“…The obtained data are consistent with the results of other studies which have proved that the initial level of neurological deficit, the cerebral syndrome severity [6,9,13], ICH volume [10][11][12] and the secondary IVH presence [14] influence had been revealed as determining factors for the vital prognosis. Detected increased blood glucose level in patients with unfavourable outcome is consistent with the study of S. V. Rogoza (2015) [2], who has claimed the connection between stress hyperglycemia and the worst SSICH outcome.…”

Intracerebral Hematoma

“…Univariate analysis had also implicated higher initial and 48-h maximum glucose concentrations, and higher percentage of ICH expansion as being significantly associated with poor functional outcome at hospital discharge. In anticoagulated patients, the initial INR or the time to INR correction did not affect the outcome [45].…”