Document Type : Original Article
Authors
- Morteza Faghih-Jouybari 1
- Mohammad Taghi Raof 1
- Sina Abdollahzade 2
- Sanaz Jamshidi 3
- Tahereh Padeganeh 4
- Saeid Ehteshami 5
- Soroush Fateh 1
1 Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Department of Neurosurgery, Rajayi Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
3 Department of Neurosurgery, Rajayi Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
4 Department of Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Neurosurgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Abstract
Background: Intracerebral hemorrhage (ICH) is the most common cause of non-ischemic strokes. Considering high mortality and poor functional status following ICH, we investigated factors that can predict short-term outcome and affect recovery of these patients.
Methods: In this prospective descriptive study, 100 patients with non-traumatic ICH were included. Clinical and radiographic data were collected and extent of disability was measured by modified Rankin Scale (mRS) at discharge, 1 week, 1 month, and 3 months after discharge.
Results: 32 of 100 cases died at hospital and 6 more expired during 3-month follow-up. Risk factors of in-hospital mortality were warfarin use, surgical intervention, and high ICH score. Functional status of patients significantly improved 3 months after discharge. Factors associated with poor recovery were age older than 70, history of coronary artery disease (CAD), low Glasgow Coma Scale (GCS) at admission, elevated mean arterial pressure (MAP), longer hospitalization, and high ICH score.
Conclusion: ICH was associated with high rate of mortality (36%). Warfarin use, surgical intervention, and high ICH score were predictive of mortality during hospitalization and 3-month follow-up. Improvement of functional status began after 1 month and significantly improved 3 months after discharge.
Keywords
- Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet 2009; 373(9675): 1632-44.
- Gonzalez-Perez A, Gaist D, Wallander MA, McFeat G, Garcia-Rodriguez LA. Mortality after hemorrhagic stroke: Data from general practice (The Health Improvement Network). Neurology 2013; 81(6): 559-65.
- Koivunen RJ, Satopaa J, Meretoja A, Strbian D, Haapaniemi E, Niemela M, et al. Incidence, risk factors, etiology, severity and short-term outcome of non-traumatic intracerebral hemorrhage in young adults. Eur J Neurol 2015; 22(1): 123-32.
- Bhatia R, Singh H, Singh S, Padma MV, Prasad K, Tripathi M, et al. A prospective study of in-hospital mortality and discharge outcome in spontaneous intracerebral hemorrhage. Neurol India 2013; 61(3): 244-8.
- Yan F, Yi Z, Hua Y, Shen Y, Li M, Ding Y, et al. Predictors of mortality and recurrent stroke within five years of intracerebral hemorrhage. Neurol Res 2018; 40(6): 466-72.
- McDowell MM, Kellner CP, Sussman ES, Bruce SS, Bruce RA, Heuts SG, et al. The role of admission timing in the outcome of intracerebral hemorrhage patients at a specialized stroke center. Neurol Res 2014; 36(2): 95-101.
- Gebel JM Jr, Jauch EC, Brott TG, Khoury J, Sauerbeck L, Salisbury S, et al. Relative edema volume is a predictor of outcome in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke 2002; 33(11): 2636-41.
- Flemming KD, Wijdicks EF, Li H. Can we predict poor outcome at presentation in patients with lobar hemorrhage? Cerebrovasc Dis 2001; 11(3): 183-9.
- Sennfalt S, Norrving B, Petersson J, Ullberg T. Long-term survival and function after stroke. Stroke 2018; STROKEAHA118022913.
- Liu J, Wang D, Yuan R, Xiong Y, Liu M. Prognosis of 908 patients with intracerebral hemorrhage in Chengdu, Southwest of China. Int J Neurosci 2017; 127(7): 586-91.
- Al-Mufti F, Thabet AM, Singh T, El-Ghanem M, Amuluru K, Gandhi CD. Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome. Interv Neurol 2018; 7(1-2): 118-36.
- Mustanoja S, Putaala J, Koivunen RJ, Surakka I, Tatlisumak T. Blood pressure levels in the acute phase after intracerebral hemorrhage are associated with mortality in young adults. Eur J Neurol 2018; 25(8): 1034-40.
- Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: A simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001; 32(4): 891-7.
- Wartenberg KE, Mayer SA. The STICH trial: The end of surgical intervention for supratentorial intracerebral hemorrhage? Curr Neurol Neurosci Rep 2005; 5(6): 473-5.
- Gregson BA, Broderick JP, Auer LM, Batjer H, Chen XC, Juvela S, et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke 2012; 43(6): 1496-504.
- An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: An Update. J Stroke 2017; 19(1): 3-10.
- van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: A systematic review and meta-analysis. Lancet Neurol 2010; 9(2): 167-76.
- Ferrete-Araujo AM, Egea-Guerrero JJ, Vilches-Arenas A, Godoy DA, Murillo-Cabezas F. Predictors of mortality and poor functional outcome in severe spontaneous intracerebral hemorrhage: A prospective observational study. Med Intensiva 2015; 39(7): 422-32.
- Bao XC, Chen H, Fang YQ, Yuan HR, You P, Ma J, et al. Clopidogrel reduces the inflammatory Response of lung in a rat model of decompression sickness. Respir Physiol Neurobiol 2015; 211: 9-16.
- Koivunen RJ, Satopaa J, Haapaniemi E, Strbian D, Meretoja A, Mustanoja S, et al. Predictors of early mortality in young adults after intracerebral hemorrhage. Stroke 2014; 45(8): 2454-6.
- Poon MT, Fonville AF, Al-Shahi SR. Long-term prognosis after intracerebral haemorrhage: Systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2014; 85(6): 660-7.
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