ปัจจัยที่มีความสัมพันธ์กับการเสียชีวิตภายใน 30 วันของผู้ป่วยภาวะวิกฤตเลือดออกในสมอง ชนิดปฐมภูมิเฉียบพลันในโรงพยาบาลระดับตติยภูมิ

Maneechanok Sammanee; Kritsana Cherboonmee

Authors

Maneechanok Sammanee Pranangklao Hospital
Kritsana Cherboonmee Pranangklao Hospital, Nonthaburi

Keywords:

intracerebral hemorrhage, 30-day mortality

Abstract

Objective: Spontaneous primary intracerebral hemorrhage (ICH) carries a high mortality, particularly among critically ill patients. Identifying factors associated with mortality supports risk assessment, treatment planning, and communication with families. This study aimed to identify factors associated with 30-day in-hospital mortality among patients with acute spontaneous primary ICH in the neurosurgical intensive care unit, Pranangklao Hospital, Nonthaburi.

Methods: A retrospective cohort study was conducted in patients admitted during fiscal years 2023–2025 (B.E. 2566–2568). Nine pre-specified independent variables were analyzed using Firth’s penalized logistic regression with a pre-specified primary model. Missing data were handled using multiple imputation by chained equations (MICE), and the robustness of the findings was examined through sensitivity analyses.

Results: Among 180 patients, 30-day in-hospital mortality was 81.1%. Factors independently and significantly associated with mortality were hematoma volume (adjusted OR 1.22 per 10 mL; 95% CI 1.08–1.43), intraventricular hemorrhage (adjusted OR 3.87; 95% CI 1.51–10.04), and lower Glasgow Coma Scale (adjusted OR 0.88 per point; 95% CI 0.79–0.99). The model showed good discrimination (AUC = 0.807). In contrast, age, systolic blood pressure, infratentorial hematoma location, blood glucose, and midline shift were not independently associated with mortality after adjustment for disease severity. These findings were robust across multiple sensitivity analyses.

Conclusion: Hematoma volume, intraventricular hemorrhage, and lower Glasgow Coma Scale are factors independently associated with 30-day in-hospital mortality. The findings may aid risk assessment in the intensive care unit and should be interpreted cautiously in the context of goals-of-care decisions.

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