In-hospital intracerebral hemorrhage: A comprehensive characterization of a provincial cohort

Compared to community-onset intracerebral hemorrhage (ICH), in-hospital ICH is understudied despite its potentially increased morbidity and mortality. We described the clinical profile and outcomes of in-hospital ICH patients in a provincial cohort.

We conducted a retrospective cohort study of adults with in-hospital ICH across acute-care hospitals in Alberta (2018-2022). Demographic, clinical, radiographic, laboratory, and outcome variables were collected from administrative data and chart review. We compared survivors and non-survivors, and performed multivariable logistic regression to determine variables associated with in-hospital mortality, including age, NIHSS, prior ICH, antithrombotic use, ICH volume and location. We performed sensitivity analyses using complete-case analysis and multiple imputation.

Among 222 patients (median age 66 years (IQR 56-76); 45.1% women), in-hospital mortality was 59.0% (n = 131) with 45.0% of deaths occurring within 7 days. Compared with survivors, non-survivors had higher NIHSS scores (median 26 vs. 7; p < 0.001), larger hematoma volumes (median 47.1 vs. 8.3 mL; p < 0.001), and more frequent intraventricular extension (55.7% vs. 29.7%; p < 0.001). Rates of comorbidities, prior ICH, alcohol use, liver disease, hematologic conditions and antithrombotic use were similar between groups. In the primary analysis, age (OR 1.03; 95% CI [1.00-1.06]), higher NIHSS scores (NIHSS 6-15: OR 4.21 [1.33-13.35]; NIHSS 21-42: OR 19.81 [5.94-66.03]), and larger hematoma volumes (OR 1.01 per mL [1.00-1.02]) were significantly associated with mortality. The association between hematoma volume and mortality was not statistically significant in sensitivity analyses.

In-hospital ICH was associated with high early mortality. Age and greater stroke severity were associated with in-hospital mortality.