Prognosis Factors for In-hospital Mortality in Spontaneous Intracerebral Hemorrhage
Keywords:
Prognostic factors, Intracerebral hemorrhage, In-hospital mortalityAbstract
Background: Spontaneous intracerebral hemorrhage has the highest mortality of cerebrovascular disease. Previous studies have examined factors contributing to death using binary outcomes but have not analyzed time to death.
Objective: To study prognostic factors for in-hospital mortality in spontaneous intracerebral hemorrhage.
Method: This retrospective cohort design of prognostic research included patients with spontaneous intracerebral hemorrhage from January 2018 to January 2023. Study variable factor and follow time to death refer to the number of days from diagnosis until death within 90 days of hospitalization. Statistical analysis included proportional hazard (PH assumption), then univariable and multivariable Cox’s PH regression analysis; results were presented using the Hazard Ratio, 95% CI, p-value < 0.05, and Kaplan-Meier survival curve. Results: 799 patients were eligible during the period; 153 patients were excluded, and 646 patients were included in the analysis. The mortality rate was 20.7%. Most of the patients were male, with an average age of 60. Multivariable analyses demonstrated that the prognostic factors of mortality included the Glasgow Coma Scale ≤ 8. [mHR 6.33 (95% CI 3.86-10.37), p < 0.001], intraventricular hemorrhage [mHR 5.31 (95% CI 2.94-9.58), p < 0.001], infratentorial location [mHR 2.73 (95% CI 1.51-4.94), p = 0.001], midline shift ≥ 5mm [mHR 2.08 (95% CI 1.04-4.16 p = 0.038], stroke in the young (age ≤ 45 years) [mHR 2.21 (95% CI 1.40-3.47), p = 0.001] and male sex [mHR 1.86 (95% CI 1.25-2.77), p = 0.002]. The prognostic factor for decreased mortality included surgery [mHR 0.25 (95% CI 0.15-0.41), p < 0.001] and door to target SBP in 1 hour [mHR 0.62 (95% CI 0.41-0.93), p = 0.020]. 138 (21.4%) patients underwent a neurosurgical intervention; 106 (76.8%) patients among the survivors compared with 32 (23.2 %) patients who died. Independent predictors of mortality included intraventricular hemorrhage [mHR 6.31 (95% CI 1.49-26.83), p = 0.013] and midline shift > 10 mm [mHR 4.25 (95% CI 1.17-15.39 p = 0.027]
Conclusion: Glasgow Coma Scale ≤ 8, intraventricular hemorrhage, infratentorial location, midline shift ≥ 5 mm, stroke in the young (age ≤ 45 years), and male sex were significant predictors of in-hospital mortality in a spontaneous intracerebral hemorrhage, whereas surgical therapy and reducing blood pressure to target within 1 hour decreased the in-hospital mortality. Intraventricular hemorrhage and midline shift > 10 mm were predictors of in-hospital mortality in patients who underwent neurosurgical intervention. To reduce death, management for spontaneous intracerebral hemorrhage cases needed to focus on targeting these factors.
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