A prospective study of in-hospital mortality and discharge outcome in spontaneous intracerebral hemorrhage

作者：Bhatia Rohit^*; Singh Hariom; Singh Shaily; Padma Madakasira V; Prasad Kameshwar; Tripathi Manjari; Kumar Guresh; Singh Mamta Bhushan

来源：Neurology India, 2013, 61(3): 244-248.

DOI：10.4103/0028-3886.115062

• Intracerebral hemorrhage
• mortality
• outcome
• stroke

Background: Intracerebral hemorrhage (ICH) is associated with high mortality and morbidity. Various clinical and imaging predictors of mortality have been observed in previous studies. Aims: To study factors associated with in-hospital mortality in patients with ICH and observe the disability status of patients [assessed by modified Rankin scale (mRS)] at the time of discharge. Design: Prospective observational study. Materials and Methods: All consecutive patients with acute hypertensive ICH admitted during the study period were enrolled. Data recorded included: Demographics, clinical, biochemical and cranial computed tomography (CT) findings. Primary outcome was defined as either death or survival within the hospital. mRS was used to assess outcome at discharge. Results: Of the total 214 patients with ICH (193 supratentorial and 21 infratentorial), 70 (32.7%) patients died during the hospital stay. On bivariate analysis, low Glasgow Coma Scale (GCS) score, ventilatory assistance, higher hematoma volume, midline shift, hydrocephalus and intraventricular hematoma (IVH) were associated with mortality. ICH grading scale (ICH-GS) and ICH scores were higher in patients who died (P < 0.0001). Ninety-five (44.6%) patients underwent a neurosurgical intervention; 66 (45.8%) patients among the survivors compared with 29 (41.4%) among those who died (P = 0.54, Odds Ratio (OR) 0.83, 95% Confidence Interval (CI) 0.46-1.48). Independent predictors of mortality included a higher baseline hematoma volume (P = 0.04 OR 1.01, 95% CI 1.00-1.02), lower GCS (P = 0.01 OR 2.57, 95% CI 1.25-5.29), intraventricular extension of hematoma (P = 0.007 OR 2.66, 95% CI 1.26-5.56) and ventilatory requirement (P < 0.0001 OR 8.34, 95% CI 2.75-25.38). Among survivors (n = 144), most were disabled [mRS 0-3, 7 (4.8%) and mRS 4-5, 137 (95.13%)] at discharge. Conclusions: Low GCS, higher baseline ICH volume, presence of IVH and need for ventilatory assistance are independent predictors of mortality. Most of the patients at discharge were disabled. Surgery did not improve mortality or outcome.

• 出版日期2013-6
• 单位河北医科大学