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Published on: August 24, 2011
The "SALPARE study" of spontaneous intracerebral hemorrhage: part 1
Ludovica De Rosa1, Renzo Manara2, Francesca Vodret3
1Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy. ludovica.derosa@studenti.unipd.it.
Insights
This study identified four key factors—pre-ICH mRS, GCS, hematoma volume, and NIHSS scores—that independently predict outcomes in patients with spontaneous intracerebral hemorrhage, aiding secondary prevention strategies.
Area of Science:
- Neurology
- Stroke Medicine
- Epidemiology
Background:
- Spontaneous intracerebral hemorrhage (ICH) is a severe stroke subtype with significant patient and family impact.
- Increasing oral anticoagulant use and an aging population may alter ICH epidemiology.
- A contemporary study was needed to assess current trends and identify early prognostic factors for secondary prevention.
Purpose of the Study:
- To provide an updated epidemiological picture of non-traumatic intracerebral hemorrhage.
- To identify early prognostic factors for predicting 90-day clinical outcomes.
- To improve secondary prevention strategies for ICH patients.
Main Methods:
- A multicenter prospective cohort study involving consecutive adult patients with non-traumatic ICH.
- Data collected from three Italian academic hospitals over a two-year period.
- Analysis correlated demographic, vascular risk, clinical, and radiological characteristics with 90-day outcomes.
Main Results:
- Out of 682 patients, 40% died and 36% had severe disability at 90 days.
- Factors associated with poor outcomes included antithrombotic use, hyperglycemia, prior stroke, low platelets, and hemorrhage location/type.
- Multivariate analysis revealed pre-ICH mRS score, GCS, initial hematoma volume, and NIHSS score as independent predictors of death and poor outcome.
Conclusions:
- Despite inter-center heterogeneity, four simple prognostic factors were identified for ICH.
- These factors independently predict patient outcomes and can stratify risk.
- The identified factors can guide clinical management and secondary prevention efforts for intracerebral hemorrhage.
Background:
Spontaneous intracerebral hemorrhage (ICH) is a devastating type of stroke with a huge impact on patients and families. Expanded use of oral anticoagulants and ageing population might contribute to an epidemiological change. In view of these trends, we planned a study to obtain a contemporary picture and identify early prognostic factors to improve secondary prevention.
Methods:
This multicenter prospective cohort study included consecutive adult patients with non-traumatic ICH admitted to three academic Italian hospitals (Salerno, Padova, Reggio Emilia) over a 2-year period. Demographic characteristics, vascular risk profile, clinical data and main radiological characteristics were correlated to 90-day clinical outcome.
Results:
Out of 682 patients [mean age: 73 ± 14 years; 316 (46.3%) females] enrolled in this study, 40% died [86/180 (47.8%) in Salerno, 120/320 (37.5%) in Padova, 67/182 (36.8%) in Reggio Emilia; p < 0.05)] and 36% were severely disabled at 90 days. Several factors were associated with a higher risk of poor functional outcome such as antithrombotic drug use, hyperglycemia, previous cerebrovascular accident, low platelet count, and pontine/massive/intraventricular hemorrhage. However, at multivariate analysis only pre-ICH mRS score (OR 30.84), GCS score at presentation (OR 11.88), initial hematoma volume (OR 29.71), and NIHSS score at presentation (OR 25.89) were independent predictors of death and poor functional outcome.
Conclusion:
Despite the heterogeneity among centers, this study on ICH has identified four simple prognostic factors that can independently predict patients outcome, stratify their risk, and guide their management.
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