Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans

Abstract

Background and Purpose:Intracerebral hemorrhage (ICH) constitutes now 52% of all strokes. Despite of its deadly pattern, locally there is no clinical grading scale for ICH-related mortality prediction. The first objective of this study was to develop a risk stratification scale (Kinshasa ICH score) by assessing the strength of independent predictors and their association with in-hospital 30-day mortality. The second objective of the study was to create a specific local and African model for ICH prognosis.Materials and Methods:Age, sex, hypertension, type 2 diabetes mellitus (T2DM), smoking, alcohol intake, and neuroimaging data from CT scan (ICH volume, Midline shift) of patients admitted with primary ICH and follow-upped in 33 hospitals of Kinshasa, DR Congo, from 2005 to 2008, were analyzed using logistic regression models.Results:A total of 185 adults and known hypertensive patients (140 men and 45 women) were examined. 30-day mortality rate was 35% (n=65). ICH volume>25 mL (OR=8 95% CI: 3.1-20.2; P<0.0001), presence of coma (OR=6.8 95% CI 2.6-17.4; P<0.0001) and left hemispheric site of ICH (OR 2.6 95% CI: 1.1-6; P=0.027) were identified as significant and independent predictors of 30-day mortality. Midline shift > 7 mm, a consequence of ICH volume, was also a significant predictor of mortality. The Kinshasa ICH score was the sum of individual points assigned as follows: Presence of coma coded 2 (2 × 2 = 4), absence of coma coded 1 (1 × 2 = 2), ICH volume>25 mL coded 2 (2 × 2=4), ICH volume of ≤25 mL coded 1(1 × 2=2), left hemispheric site of ICH coded 2 (2 × 1=2), and right hemispheric site of hemorrhage coded 1(1 × 1 = 1). All patients with Kinshasa ICH score ≤7 survived and the patients with a score >7 died. In considering sex influence (Model 3), points were allowed as follows: Presence of coma (2 × 3 = 6), absence of coma (1 × 3 = 3), men (2 × 2 = 4), women (1 × 2 = 2), midline shift ≤7 mm (1 × 3 = 3), and midline shift >7 mm (2 × 3 = 6). Patients who died had the Kinshasa ICH score ≥16.Conclusion:In this study, the Kinshasa ICH score seems to be an accurate method for distinguishing those ICH patients who need continuous and special management. It needs to be validated among large African hypertensive populations with a high rate of 30-day in–hospital mortality.

Prognostic models for intracerebral hemorrhage: systematic review and meta-analysis

“… 0·810 (0·033) Tshikwela [ 36 ] 2012 Black hypertensive primary ICH Score Discharge GCS, ICH volume, left hemisphere involved. – Tshikwela´ [ 36 ] 2012 Black hypertensive primary ICH Score Discharge Gender, GCS, midline shift. – Tuhrim [ 23 ] 1999 Primary supratentorial ICH managed medically Equation 30 days GCS, ICH volume, pulse pressure, hydrocephalus, and IVH volume.…”

“…However, several studies included further specifications for patient inclusion namely age [ 12 ], cerebral amyloid related angiopathy [ 13 ], deep location [ 14 – 17 ], lobar location [ 18 ], supratentorial bleeds [ 16 , 19 – 33 ], presence of intraventricular hemorrhage [ 16 , 34 , 35 ], African ethnicity [ 36 ], non-comatose patients [ 22 , 37 ], comatose patients [ 38 ], medically treated patients [ 22 – 25 , 27 , 33 , 38 – 40 ], surgically treated patients [ 21 ], oral anticoagulant related bleeds [ 41 ], hypertensive patients [ 19 , 36 ], and dialysis patients [ 40 ]. The majority of studies ( n = 40) recruited patients from hospitals or emergency rooms [ 10 – 14 , 16 – 22 , 26 , 29 – 31 , 36 , 40 – 61 ] but nine studies recruited patients from intensive care units [ 24 , 28 , 32 , 33 , 35 , 38 , 62 – 64 ], three studies recruited patients from stroke units [ 34 , 37 , 65 ], six studies recruited patients from neurology/neurosurgery departments [ 15 , 25 , 27 , 39 , 66 , 67 ], and one study recruited patients from both an intensive care unit and a stroke unit [ 23 ]. Most prognostic tools were derived from cohort studies, with the exceptions being registries [ 29 , …”

The Clinical Epidemiology of Spontaneous ICH in a Sub-Sahara African Country in the CT Scan Era: A Neurosurgical In-Hospital Cross-Sectional Survey

“…There is even a greater paucity of data-driven scientific reports on the pattern of sICH in LMIC. We are aware of only one or so ( 25 ). Yet, there is increasing empirical evidence that the incidence and frequency of sICH in these regions are much higher than in the west; 29–60% versus 16–20% ( 4 , 5 , 19 ).…”

A novel risk score to predict 1-year functional outcome after intracerebral hemorrhage and comparison with existing scores

“…Moreover, the existing ICH scores were mainly designed for short-term (in-hospital or 30 days after ICH) [6-8,10,13-16] or intermediate-term (three months after ICH) [9,11] outcome prediction. Studies have shown that a substantial proportion of ICH patients continue to improve throughout the first year after ICH [17].…”