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Published on: July 3, 2014
Predictors of spontaneous intracerebral hemorrhage mortality: a community-based study in Brno, Czech Republic
Albert Sterba1,2,3,4, Petra Sedova5,6,7,8, Robert D Brown9
1International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic.
Insights
Predictors of long-term mortality after intracerebral hemorrhage (ICH) include neurological deficit severity (NIHSS), patient age, and ICH size. Cardiac history also impacts survival rates after spontaneous ICH.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Intracerebral hemorrhage (ICH) is a critical condition with high mortality rates.
- Factors influencing long-term survival post-ICH remain incompletely understood.
- This study investigates predictors of long-term mortality in a community-based ICH cohort.
Purpose of the Study:
- To identify independent predictors of short-term and long-term mortality following spontaneous intracerebral hemorrhage.
- To assess the impact of demographic, clinical, and radiographic factors on ICH outcomes.
Main Methods:
- A community-based cohort of spontaneous ICH patients admitted in 2011 was identified in Brno, Czech Republic.
- Data on risk factors, neurological deficit (NIHSS), and ICH characteristics were collected.
- Mortality at 30 days, 6 months, 1 year, and 3 years was determined using the National Mortality Register.
- Multivariate logistic regression analysis identified independent predictors of mortality.
Main Results:
- The 3-year mortality rate for spontaneous ICH was 63%.
- Higher mortality was observed with increased age, larger ICH size, and higher NIHSS scores.
- History of cardiac failure, myocardial infarction, and atrial fibrillation were associated with increased mortality, particularly short-term.
Conclusions:
- Neurological deficit severity (NIHSS), age, and ICH size are significant predictors of both short- and long-term mortality after spontaneous ICH.
- Pre-existing cardiac conditions are important factors influencing survival post-ICH.
- Optimal cardiac management is crucial for improving outcomes in patients with intracerebral hemorrhage.
Background And Objective:
Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH.
Methods:
We identified all patients admitted with spontaneous ICH to hospitals with a certified stroke unit in Brno, the second largest city in the Czech Republic (CR), in 2011, the year of the Czech Population and Housing Census. We reviewed their medical records for risk factors, radiographic parameters, and measures of post-stroke neurological deficit [National Institutes of Health Stroke Scale (NIHSS)]. Using the dates of death from the Czech National Mortality Register, we calculated mortality at 30 days, six months, one year, and three years after the ICH. Multivariate analysis with forward stepwise logistic regression was performed to determine independent predictors of mortality (p < 0.05).
Results:
In 2011, 1086 patients with stroke were admitted to the four stroke-certified hospitals in Brno, CR. Of these, 134 had spontaneous ICH, with complete data available in 93 of them entering the final analysis. The mortality at 30 days, 6 months, 1 year, and 3 years post-ICH was 34%, 47%, 51%, and 63%, respectively. The mortality was highest in the first few days post-event, with 50% of patients dying in 255 days and average survival being 884 ± 90 days. Both NIHSS and modified ICH (MICH) score showed to be strong and reliable predictors of short- as well as long-term mortality; the risk of death post-ICH increased with older age and size of ICH. Other risk factors contributing to higher, primarily shorter-term mortality included history of cardiac failure, myocardial infarction, or atrial fibrillation.
Conclusions:
In our community-based study, we found that severity of neurological deficit at admission (NIHSS), combined with age and size of ICH, well predicted short- as well as long-term mortality after spontaneous ICH. A history of cardiac failure, myocardial infarction, or atrial fibrillation at presentation were also predictors of mortality, underscoring the need for optimal cardiac management in patients with ICH.
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