Mortality, Functional Status, and Quality of Life after 5 Years of Patients Admitted to Critical Care for Spontaneous Intracerebral Hemorrhage

Marina Gordillo-Resina; Consuelo Aranda-Martinez; Maria Dolores Arias-Verdú; Francisco Guerrero-López; Encarnación Castillo-Lorente; David Rodríguez-Rubio; Ricardo Rivera-López; Carmen Rosa-Garrido; Francisco Javier Gómez-Jiménez; Jesus Lafuente-Baraza; Eduardo Aguilar-Alonso; Miguel Angel Arráez-Sánchez; Ricardo Rivera-Fernández

doi:10.1007/s12028-024-01960-0

Mortality, Functional Status, and Quality of Life after 5 Years of Patients Admitted to Critical Care for Spontaneous Intracerebral Hemorrhage

Neurocrit Care. 2024 Apr 8. doi: 10.1007/s12028-024-01960-0. Online ahead of print.

Authors

Affiliations

¹ Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
² Intensive Care Unit, Reina Sofía University Hospital, Córdoba, Spain.
³ Intensive Care Unit, Hospital Regional Universitario, Málaga, Spain.
⁴ Intensive Care Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.
⁵ Neurosurgery Department, Hospital del Mar, Barcelona, Spain.
⁶ Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
⁷ Biosanitary Research Foundation in Eastern Andalusia, Alejandro Otero, Hospital Universitario de Jaén, Jaén, Spain.
⁸ Department of Medicine, School of Medicine, University of Granada, Granada, Spain.
⁹ Intensive Care Unit, Reina Sofía University Hospital, Córdoba, Spain. eaguia@yahoo.es.
¹⁰ Neurosurgery Department, Hospital Regional Universitario de Málaga, Málaga, Spain.
¹¹ Intensive Care Unit, Complejo Hospitalario de Jaén, Jaén, Spain.

PMID: 38589693
DOI: 10.1007/s12028-024-01960-0

Abstract

Background: The objective of this study was to assess long-term outcome in patients with spontaneous intracerebral hemorrhage admitted to the intensive care unit.

Methods: Mortality and Glasgow Outcome Scale, Barthel Index, and 5-level EQ-5D version (EQ-5D-5L) scores were analyzed in a multicenter cohort study of three Spanish hospitals (336 patients). Mortality was also analyzed in the Medical Information Mart for Intensive Care III (MIMIC-III) database.

Results: The median (25th percentile-75th percentile) age was 62 (50-70) years, the median Glasgow Coma Score was 7 (4-11) points, and the median Acute Physiology and Chronic Health disease Classification System II (APACHE-II) score was 21 (15-26) points. Hospital mortality was 54.17%, mortality at 90 days was 56%, mortality at 1 year was 59.2%, and mortality at 5 years was 66.4%. In the Glasgow Outcome Scale, a normal or disabled self-sufficient situation was recorded in 21.5% of patients at 6 months, in 25.5% of patients after 1 year, and in 22.1% of patients after 5 years of follow-up (4.5% missing). The Barthel Index score of survivors improved over time: 50 (25-80) points at 6 months, 70 (35-95) points at 1 year, and 90 (40-100) points at 5 years (p < 0.001). Quality of life evaluated with the EQ-5D-5L at 1 year and 5 years indicated that greater than 50% of patients had no problems or slight problems in all items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). In the MIMIC-III study (N = 1354), hospital mortality was 31.83% and was 40.5% at 90 days and 56.2% after 5 years.

Conclusions: In patients admitted to the intensive care unit with a diagnosis of nontraumatic intracerebral hemorrhage, hospital mortality up to 90 days after admission is very high. Between 90 days and 5 years after admission, mortality is not high. A large percentage of survivors presented a significant deficit in quality of life and functional status, although with progressive improvement over time. Five years after the hemorrhagic stroke, a survival of 30% was observed, with a good functional status seen in 20% of patients who had been admitted to the hospital.

Keywords: Critical care; Intensive care unit; Mortality; Prognostic; Spontaneous intracerebral hemorrhage.