Predictors of mortality and poor functional outcome in severe spontaneous intracerebral hemorrhage: a prospective observational study

Abstract

Objective: To analyze mortality and functional outcome in patients with severe spontaneous intracerebral hemorrhage (ICH), and identify the clinical characteristics, radiological findings and therapeutic procedures predictive of mortality in the Intensive Care Unit (ICU) and during hospitalization, as well as of poor functional results at 6 months.

Design: A prospective, observational study was carried out.

Setting: Neurocritical Care Unit of a university hospital.

Patients: Patients diagnosed with ICH were included over a period of 23 months.

Variables of interest: Demographic characteristics, cardiovascular risk factors, regular medication, laboratory test parameters, cranial CT findings, therapeutic procedures and outcome data.

Intervention: None.

Results: A total of 186 patients with ICH met the inclusion criteria. Surgery to evacuate ICH was performed in 25.8% of the patients. The mortality rate was 46.7%. The modified Rankin score at 6 months was 5 (RI: 4.6). Multivariate Cox regression analysis showed the presence of diabetes, prior anticoagulation, as well as APACHE II severity and the type of bleeding on the cranial CT scan to be predictors of mortality and poor functional outcomes. On the other hand, neurosurgical procedures and intracranial pressure (ICP) monitoring were associated with better outcomes.

Conclusion: The presence of comorbidities such as diabetes, or previous anticoagulation, as well as the CT findings were associated to poorer outcomes. In contrast, ICP monitoring and early neurosurgery were predictive of longer survival and better functional outcomes.

Keywords: Hemorragia intraparenquimatosa; Intensive Care Unit; Intracerebral hemorrhage; Mortalidad; Mortality; Outcome; Pronóstico; Unidad de Cuidados Intensivos.