Factors Associated With 90-Day Functional Outcome After Neurosurgical Management of Hypertensive Intracerebral...

Prognostic factors after intracerebral hemorrhage (ICH) are well described, but evidence from surgically selected hypertensive ICH cohorts remains limited. This study examined preoperative clinical, hemodynamic, and radiographic factors associated with the full 90-day modified Rankin Scale (mRS) distribution in patients who underwent neurosurgical management for hypertensive ICH.

This retrospective single-center cohort used a prospectively maintained stroke registry at Hamad Medical Corporation, Qatar, from 2013 through 2024. The registry contained 113 adults who underwent neurosurgical management for hypertensive ICH. The primary outcome was 90-day mRS (0-6). Because mRS is ordinal, the primary analysis used cumulative-logit ordinal logistic regression. The prespecified model included age, admission mean arterial pressure (MAP), admission pulse pressure, admission Glasgow Coma Scale (GCS) score, first preoperative CT hematoma volume, and midline shift. Complete-case analysis was used.

Ninety-day mRS was available for 95 of 113 patients; 87 had complete data for the primary model. Median 90-day mRS was 4 [IQR, 3-5]. Older age was associated with greater odds of a worse 90-day mRS category (adjusted OR per 10 years, 1.58; 95% CI, 1.10-2.27; p = 0.012), whereas higher admission GCS was associated with lower odds of a worse category (adjusted OR per point, 0.88; 95% CI, 0.79-0.97; p = 0.013). The confidence intervals for MAP, pulse pressure, hematoma volume, and midline shift included the null.

In this surgically selected hypertensive ICH cohort, older age and lower admission GCS were associated with worse 90-day functional status. The study does not establish new prognostic factors, treatment benefit, or a validated prediction model; rather, it provides cohort-specific evidence using an analysis aligned with the ordinal structure of mRS.