Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage

Diaa A Safatli; Albrecht Günther; Peter Schlattmann; Falko Schwarz; Rolf Kalff; Christian Ewald

doi:10.4103/2152-7806.187493

Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage

Surg Neurol Int. 2016 Aug 1;7(Suppl 18):S510-7. doi: 10.4103/2152-7806.187493. eCollection 2016.

Authors

Diaa A Safatli¹, Albrecht Günther², Peter Schlattmann³, Falko Schwarz¹, Rolf Kalff¹, Christian Ewald¹

Affiliations

¹ Department of Neurosurgery, Informatics and Documentation, Friedrich Schiller University, Jena, Germany.
² Department of Neurology, Informatics and Documentation, Friedrich Schiller University, Jena, Germany.
³ Department of Medical Statistics, Informatics and Documentation, Friedrich Schiller University, Jena, Germany.

Abstract

Background: Intracerebral hemorrhage (ICH) is a life threatening entity, and an early outcome assessment is mandatory for optimizing therapeutic efforts.

Methods: We retrospectively analyzed data from 342 patients with spontaneous primary ICH to evaluate possible predictors of 30-day mortality considering clinical, radiological, and therapeutical parameters. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study.

Results: From 342 patients (mean age: 67 years, mean Glasgow Coma Scale [GCS] on admission: 9, mean ICH volume: 62.19 ml, most common hematoma location: basal ganglia [43.9%]), 102 received surgical and 240 conservative treatment. The 30-day mortality was 25.15%. In a multivariate analysis, GCS (Odds ratio [OR] =0.726, 95% confidence interval [CI] =0.661-0.796, P < 0.001), bleeding volume (OR = 1.012 per ml, 95% CI = 1.007 - 1.017, P < 0.001), and infratentorial hematoma location (OR = 5.381, 95% CI = 2.166-13.356, P = 0.009) were significant predictors for the 30-day mortality. After receiver operating characteristics analysis, we defined a "high-risk group" for an unfavorable short-term outcome with GCS <11 and ICH volume >32 ml supratentorially or 21 ml infratentorially. Using Pearson correlation, we found a correlation of 0.986 between ICH score and 30-day mortality (P < 0.001), 0.853 between FUNC score and 30-day mortality (P = 0.001), and 0.924 between ICH-GS and 30-day mortality (P = 0.001).

Conclusions: GCS score on admission together with the baseline volume and localization of the hemorrhage are strong predictors for 30-day mortality in patients with spontaneous primary intracerebral hemorrhage, and by relying on them it is possible to identify high-risk patients with poor short-term outcome. The ICH score and the ICH-GS accurately predict the 30-day mortality.

Keywords: Cerebral hemorrhage; multivariate analysis; prognosis; risk factors; treatment outcome.