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Intracerebral hemorrhage survival: French register data
B el Chami1, C Milan, M Giroud
1Neurology Department, Dijon University Hospital, Dijon, France.
Insights
Consciousness disorders are the main predictor of death after cerebral hemorrhage. Intraventricular hemorrhage and hematoma volume also significantly impact short-term survival in these patients.
Area of Science:
- Neurology
- Neurosurgery
- Public Health
Background:
- Cerebral hemorrhages have high short- and long-term mortality rates.
- Understanding prognostic factors is crucial for managing patients of all ages, regardless of treatment.
- Population-based studies offer valuable insights into survival and risk factors.
Purpose of the Study:
- To identify predictive factors for short- and long-term survival after cerebral hemorrhage.
- To analyze relative survival rates based on clinical and CT-scanning variables.
- To inform acute management strategies and future therapeutic trial designs.
Main Methods:
- Retrospective analysis of 183 patients with cerebral hemorrhage in Dijon, France (1985-1996).
- Inclusion of 18 clinical and CT-scanning variables for prognostic assessment.
- Statistical analysis using odds ratios (OR) to determine predictive significance.
Main Results:
- Four factors predicted one-month mortality: consciousness disorders (OR=5.80), intraventricular hemorrhage (OR=5.60), hematoma volume >11 cm³ (OR=3.53), and age >70 in males (OR=4.90).
- Consciousness disorders were the primary predictor of both crude and relative long-term survival (OR=5.52 crude, OR=22.2 relative).
- Age >70 also predicted long-term survival (OR=3.71 crude, OR=2.41 relative).
Conclusions:
- Consciousness disorders at initial examination are the strongest predictor of poor short- and long-term survival.
- Intraventricular hemorrhage and hematoma volume are significant short-term negative prognostic factors.
- Population-based data are vital for optimizing acute care and guiding research in cerebral hemorrhage management.
Abstract:
Cerebral hemorrhages are subject to a heavy short- and long-term case fatality. A study of prognostic factors and of relative survival based on the data of a population registry is of great value to study patients having a hematoma of all ages, irrespective of the method of care. We have listed 183 patients having a cerebral hemorrhage between 1 January 1985 and 31 December 1996 and living in the city of Dijon, France. Eighteen clinical and CT-scanning variables have been studied. We have found four predictive factors of death at one month from cerebral hemorrhages. These are, in decreasing order: the existence of consciousness disorders at the initial clinical examination (OR = 5.80, p < 0.0001); an intraventricular hemorrhage (OR = 5.60, p < 0.0001); a hematoma volume over 11 cubic centimeters (OR = 3.53, p = 0.027); lastly, in male patients an age over 70 years (OR = 4.90, p = 0.039). With regard to long-term survival, the existence of consciousness disorders remains the principal predictive factor of case fatality in both crude and relative survival (OR = 5.52, p < 0.0001, in crude survival versus OR = 22.2 in relative survival, p < 0.0001), followed by age over 70 years (OR = 3.71, p < 0.0001 in crude survival and OR = 2.41 in relative survival, p = 0.086). The existence of consciousness disorders at the initial examination following a cerebral hemorrhage would seem to be the principal worst prognostic factor of short- and long-term survival and of relative survival, age and sex having less importance. Moreover, intraventricular hemorrhage and hematoma volume are short-term, pejorative factors. These data, based on a population-based registry, are an important consideration in the acute management of hemorrhagic therapy, and for the design of further therapeutic trials on this severe pathology.