Predictors of Mortality in Spontaneous Intracerebral Hemorrhage Cases

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.