Predictors of Mortality in Spontaneous Intracerebral Hemorrhage Cases

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Published Sep 20, 2022
DOI: https://doi.org/10.18103/mra.v10i9.3131

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Main Article Content

Dr. Govinda Bongu Dr. Anuj Singhal Dr. K Kiran Kumar Dr. Saurabh Bobdey

Abstract

Aim and objectives: This study was done with the aim of finding clinical and radiological correlation of patients with spontaneous intracerebral hemorrhage (SICH) and its correlation with 90-day mortality. The primary objective was to study the clinical, laboratory and radiological predictors of mortality in patients of intracerebral hemorrhage. The secondary objective was to compare 90-day mortality in patients with spontaneous intracerebral hemorrhage with that to coagulopathy related intra cerebral hemorrhage. 


Methods: This was a longitudinal, observational study carried out from June 2020 to June 2022 at Govt hospital situated in North India. The relevant history and clinical examination was done according to pre designed and pretested protocol. All patients underwent non-contrast computerized tomography imaging, their Glasgow coma scale score and intracerebral hemorrhage score were noted. For the sake of coagulopathy related intracerebral hemorrhage, the patients were classified as taking single antiplatelet, dual antiplatelet agents and oral anti-coagulant drugs. These patients were followed up daily during the hospital stay and regularly thereafter until 90 days. Functional outcome of patients was determined by modified Rankin's scale at 30 days and 90 days. The statistical analysis was done using SPSS software.


Results: A total of 235 cases were studied. 202 patients were detected to have hypertension, out of which 25 (12.37%) deaths were recorded within 48hrs of admission, 77 (38.1%) and 85 (42%) of patients with hypertension had died at 30 days and 90 days respectively. Similarly, out of 40 diabetics in this cohort, 15 (37.5%) and 18 (45%) deaths occurred at 30 and 90 days. 97 out of 235 cases who consumed alcohol, 56 (57.7%) and 61 (62.9%) died at 30 and 90 days. Among 52 smokers in this study, 21 (40.4%) and 24 (46.2%) died at 30 and 90 days. Death at 30 and 90 days was significantly more among subjects with intracerebral hemorrhage score of 3 or more with P value of 0.001 and also in patients with GCS score less than 8. Higher mortality rates were seen among subjects with modified Rankin's scale (mRS) score 6 with P value of 0.001 at 30 days. Total number of coagulopathy related intracerebral hemorrhage cases were 99/235. On radiological correlation between spontaneous intracerebral hemorrhage and coagulopathy related intracerebral hemorrhage, this study did not find any strong correlation. The P value was 0.913 at 30 days and 0.961 at 90 days. 


Conclusion: This study found that comorbidities like hypertension and type 2 Diabetes mellitus were significant predictors of mortality in spontaneous intracerebral hemorrhage cases. The significant correlation was also found between consumption of alcohol and smoking with mortality in intracerebral hemorrhage cases. The 30 and 90-day mortality was significantly among subjects with ICH score 3 or more and also in patients with GCS score less than 8. Similarly, higher mortality is seen with higher modified Rankin score at 30 days. On radiological examination, the Intra cerebral bleed volume greater than 30 ml was greatest predictor of death. This study did not find coagulopathy as a strong predictor of mortality when compared with spontaneous modified Rankin score. Similarly, the location of intra cerebral bleed was not associated with higher mortality in this study. 

Keywords: Glasgow Coma Scale score (GCS), spontaneous intra cerebral hemorrhage (SICH), intracerebral hemorrhage score (ICH), modified Rankin score (mRS), cerebro-vascular accidents (CVA), Dual antiplatelet (DAPT), oral anticoagulant (OAC), Activities for daily living (ADL)

Article Details

How to Cite
BONGU, Dr. Govinda et al. Predictors of Mortality in Spontaneous Intracerebral Hemorrhage Cases. Medical Research Archives, [S.l.], v. 10, n. 9, sep. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3131>. Date accessed: 05 nov. 2024. doi: https://doi.org/10.18103/mra.v10i9.3131.
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Vol 10 No 9 (2022): Vol.10 Issue 9 September 2022
Section
Research Articles

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References

1. Van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral hemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010; 9(2):167–176.
2. Ikram MA, Wieberdink RG, Koudstaal PJ. International epidemiology of intracerebral hemorrhage. CurrAtheroscler Rep. 2012; 14(4):300–306.
3. O’Donnell MJ, Denis X, Liu L, et al. Risk factors for ischaemic and intracerebral hemorrhagic stroke in 22 countries (the INTERSTROKE study): A case-control study. Lancet. 2010; 376(9735): 112–123.
4. Charidimou A, Gang Q, Werring DJ. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum. J Neurol Neurosurg Psychiatry. 2012; 83(2):124–137.
5. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344:1450–60.
6. Labovitz DL, Halim A, Boden-Albala B, Hauser WA, Sacco RL. The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and Hispanics. Neurology. 2005;65:518–22.
7. Sudlow CL, Warlow CP. Comparable studies of the incidence of stroke and its pathological types: Results from an international collaboration. International stroke incidence collaboration. Stroke. 1997;28:491–9.
8. Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet. 2009;373:1632–44.
9. Nilsson OG, Lindgren A, Brandt L, Säveland H. Prediction of death in patients with primary intracerebral hemorrhage: A prospective study of a defined population. J Neurosurg. 2002;97:531–6.
10. Poungvarin N, Viriyavejakul A. Spontaneous supratentorial intracerebral haemorrhage: A prognostic study. J Med Assoc Thai. 1990;73:206–11.
11. Stroke epidemiological data of nine Asian countries. Asian acute stroke advisory panel (AASAP) J Med Assoc Thai. 2000;83:1–7.
12. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (STICH): A randomised trial. Lancet. 2005;365:387–97.
13. Juvela S, Heiskanen O, Poranen A, Valtonen S, Kuurne T, Kaste M, et al. The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg. 1989;70:755–8.
14. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM STICH II Investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebralhematomas (STICH II): A randomised trial. Lancet. 2013;382:397–408.
15. Qureshi AI, Suri MF, Nasar A, Kirmani JF, Ezzeddine MA, Divani AA, et al. Changes in cost and outcome among US patients with stroke hospitalized in 1990 to 1991 and those hospitalized in 2000 to 2001. Stroke. 2007;38:2180–4.
16. Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2:43–53.
17. Kubo M, Kiyohara Y, Kato I, Tanizaki Y, Arima H, Tanaka K, et al. Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community: The Hisayama study. Stroke. 2003;34:2349–54.
18. Jiang B, Wang WZ, Chen H, Hong Z, Yang QD, Wu SP, et al. Incidence and trends of stroke and its subtypes in China: Results from three large cities. Stroke. 2006;37:63–8.
19. Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study) Lancet. 2004;363:1925–33.
20. Vishwanath Sidram, PC Chandra Kumar, et all. A Study of Clinical Profile of Intracerebral Hemorrhage and ENT Manifestations and its Surgical Outcome. International Journal of Head and Neck Surgery, January-March 2017;8(1):5-10
21. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891–897.
22. Ajay Hegde, Girish Menon, Vinod Kumar, G. Lakshmi Prasad, Lakshman I. Kongwad, Rajesh Nair, Raghavendra Nayak, "Clinical Profile and Predictors of Outcome in Spontaneous Intracerebral Hemorrhage from a Tertiary Care Centre in South India", Stroke Research and Treatment, vol. 2020. https://doi.org/10.1155/2020/2192709.
23. Banerjee TK, Das SK. Fifty years of stroke researches in India. Ann Indian Acad Neurol. 2016 Jan-Mar;19(1):1-8. doi: 10.4103/0972-2327.168631. PMID: 27011621; PMCID: PMC4782523..
24. R. Bhatia, H. Singh, S. Singh et al., “A prospective study ofin-hospital mortality and discharge outcome in spontaneous intracerebral haemorrhage,” Neurology India, vol. 61, no. 3,p. 244, 2013.
25. S. K. Narayan, P. Sivaprasad, S. Sushma, R. K. Sahoo, and
T. K. Dutta, “Etiology and outcome determinants of intracerebral hemorrhage in a south Indian population, a hospital-basedstudy,” Annals of Indian Academy of Neurology, vol. 15, no. 4,p. 263, 2012.
26. G. Namani, D. M. Rampure, and M. Murali, “Clinical profile andmortality in patients presenting with intracerebral hemorrhagein a tertiary care centre,” Scholars Journal of Applied MedicalSciences, pp. 3005–3006, 2014.
27. NN Suthar, KL Patel, C. Saparia, and APParikh.Studyof clinical and radiological profile and outcome in patients ofintracranial hemorrhage,” Annals of African Medicine, vol. 15,no. 2, pp. 6–77, 2016
28. Al Harthi HA, Al Kashmiri A, Zakaryia LM, Al-Lawati JA, Najem OM, Al-Lawati I, Memon GR, Elfaham AA. Clinical Profile of Stroke Patients Presenting to the Emergency Department of a Major Stroke Centre in Oman. Sultan Qaboos Univ Med J. 2022 Feb;22(1):91-97. doi: 10.18295/squmj.4.2021.062. Epub 2022 Feb 28. PMID: 35299813; PMCID: PMC8904127.
29. Itagi A, Bharat G, Biradarpatil P, Pattanashetti L. A study on clinical profile of acute stroke. Int J Adv Med 2020;7:1809-14.
30. Feldmann E., Broderick J.P., Kernan W. N., et al. Major risk factors for intracerebral hemorrhage in the young are modifiable. Stroke. 2005;36(9):1881–1885. doi: 10.1161/01.STR.0000177480.62341.6b.
31. Kay Sin Tan; Navarro, Jose C.; Ka Sing Wong; Yi Ning Huang; Hou Chang Chiu; NiphonPoungvarin; Shan Jin Ryu; Bitanga, Ester; NijasriSuwanwela; Alam, Sardar Mohd; Byung Woo Yoon. Clinical profile, risk factors and aetiology of young ischaemic stroke patients in Asia: A prospective, multicentre, observational, hospital-based study in eight cities.NeurologyAsia. Jun2014, Vol. 19 Issue 2, p117-127. 11p.
32. Jun Zheng, Zhiyuan Yu, Lu Ma, Rui Guo, Sen Lin, Chao You, Hao Li. Association Between Blood Glucose and Functional Outcome in Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis,World Neurosurgery, Volume 114,2018,Pages e756-e765.
33. Ntaios G, Egli M, Faouzi M, Michel P. J-shaped association between serum glucose and functional outcome in acute ischemic stroke. Stroke (2010) 41:2366–70. 10.1161/STROKEAHA.110.592170.
34. Kurtz P, Claassen J, Helbok R, Schmidt J, Fernandez L, Presciutti M, et al. Systemic glucose variability predicts cerebral metabolic distress and mortality after subarachnoid hemorrhage: a retrospective observational study. Crit Care (2014) 18: R89. 10.1186/cc13857.
35. J Broderick, S Connolly, E Feldmann et al.Guidelines forthe management of spontaneous intracerebral hemorrhagein adults: 2007 update: a guideline from the American heartassociation/American stroke association stroke council, HighBlood Pressure Research Council, and the quality of careand outcomes in research interdisciplinary working group, Circulation, vol. 116, no. 16, pp. 391–413, 2007.
36. SM Davis, J. Broderick, M. Hennerici et al. “Hematomagrowth is a determinant of mortality and poor outcome after intracerebral hemorrhage,” Neurology, vol. 66, no. 8, pp. 1175–1181, 2006.
37. Zahuranec DB, Gonzales NR, Brown DL, Lisabeth LD, Longwell PJ, Eden SV, et al. Presentation of intracerebral haemorrhage in a community. J Neurol Neurosurg Psychiatry. 2006;77:340–4.
38. Nilsson OG, Lindgren A, Brandt L, Saveland H. Prediction of death in patients with primary intracerebral hemorrhage: A prospective study of a defined population. J Neurosurg. 2002;97:531–6.
39. Das S. K., Banerjee T. K., Biswas A., et al. A prospective community-based study of strokein Kolkata India. Stroke. 2007;38(3):906–910.doi: 10.1161/01.STR.0000258111.00319.58.
40. Poon M. T. C., Fonville A. F., Al-Shahi S. R. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. 2014;85(6):660–667. doi: 10.1136/jnnp-2013-306476.
41. Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10 yearsurvival of intracerebral hemorrhage in a population based registry.Stroke 2009;40:394 9.
42. Zia E, Engström G, Svensson PJ, Norrving B, Pessah Rasmussen H.Three year survival and stroke recurrence rates in patients with primaryintracerebral haemorrhage. Stroke 2009;40:3567 73.
43. Kim KH. Predictors of Mortality and Functional Recovery afterPrimary Intracerebral Hemorrhage. J Korean Neurosurg Soc2009;45:341 9.
44. Tshikwela ML, Longo Mbenza M. Spontaneous intracerebralhemorrhage: Clinical and computed tomography findings inpredicting in hospital mortality in Central Africans. J Neurosci RuralPract2012;3:115 20.
45. Rhoney DH, Parker D Jr, Millis SR, Whittaker P. Kidney dysfunctionat the time of intracerebral hemorrhage is associated with increasedin hospital mortality: A retrospective observational cohort study. NeurolRes 2012;5:518 21.