Prognostic determinants in patients with non traumatic intracerebral hemorrhage: a real life report

ABSTRACT

Background and aim: Nontraumatic intracerebral hemorrhage (ICH) remains a devastating disease for high in-hospital and long-term mortality and residual neurological disability. The aim of our study was to analyze the prognostic factors in patients managed for ICH in the real-life clinical practice.

Materials and Methods: We retrospectively analyzed clinical and neuro-radiological data of consecutive patients admitted to our Hospital for ICH along 1 year. In-hospital mortality and 90-day modified Rankin scale (mRS) ≥4 were the study outcomes. Moreover, we compared patients admitted in Intensive Care Unit (ICU) with patients admitted in Stroke Unit (SU).

Results: Ninety-eight patients with mean age ± SD 78 ± 12 years were enrolled. In-hospital and 90-day mortality were 36.7% and 41.8%, respectively. Patients who died had a significantly higher percentage of ICH volume >30 mL, irregular shape, lobar location, intraventricular hemorrhage (IVH), midline shift, hydrocephalus, hematoma enlargement, Glasgow Coma Scale (GCS) ≤9 at hospital admission, early neurological worsening (ENW), higher Hemphill ICH score, and underwent oro-tracheal intubation more frequently compared with patients who survived. Patients admitted to ICU were younger and significantly more critical compared with those who were admitted to SU. In-hospital mortality in patients admitted to ICU was 52.6% compared with 25% in patients admitted to SU (p < 0.01). Median mRS score at hospital discharge was 4 (IQR 3–5) and at 90 days was 4 (IQR 3–4). ENW, hematoma enlargement, Hemphill ICH score ≥3 and midline shift >10 mm were found independent risk factors for in-hospital mortality, while age was found as independent risk factor for 90-day mRS ≥4).

Conclusion: In real life, prognosis of ICH is associated with clinical and radiological determinants. In our study ENW, hematoma enlargement, Hemphill ICH score ≥3 and midline shift >10 mm were associated with short-term mortality risk, while age with 90-day mRS ≥4.

KEYWORDS:

• Intracerebral hemorrhage
• prognosis
• mortality
• score
• anticoagulants

Acknowledgments

The Authors thank all physicians, nurses and physiotherapists of the Emergency Department, Radiology, Intensive Care Unit, Sub-Intensive Care Unit, Stroke Unit, Internal Medicine II wards and Rehabilitation Unit of San Giuseppe Hospital of Empoli (Florence), Italy, all physicians, nurses and physiotherapists of Physical Medicine and Rehabilitation Unit of San Miniato Hospital (Pisa), Italy and all physicians of Neurosurgery Unit and Neurointensive Care Unit of Careggi Hospital (Florence), Italy, for the contribute and collaboration in management of patients suffering from ICH.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

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