Outcome of intensive care unit patients with spontaneous intracerebral hemorrhage

Introduction

We evaluated the factors that may influence the outcome of patients with spontaneous intracerebral hemorrhage (SICH).

Methods

Retrospective analysis of prospectively gathered data of 102 patients with SICH treated in our ICU during the past 8 years. On admission the following data were registered: vascular risk factors (high blood pressure, diabetes mellitus), age, gender, APACHE II score, GCS, hemorrhage characteristics (location, side, volume, mass effect), surgical procedure, MODS, blood pressure (systolic, diastolic, mean), pulse pressure, pulse rate, laboratory parameters (hemoglobin, white cell and platelet count, INR, serum values for Na, glucose, lactate, creatinin, bilirubin). Also registered were length of stay (LOS), duration of mechanical ventilation (MV), time of intubation (TT) and patient outcome. Haemodynamic instability was defined as low mean blood pressure and support with vasoactive and inotrop drugs. Statistical evaluation was performed using univariate and multivariate logistic regression, Student's t test Pearson's chi-square test and Fisher's exact statistic were used.

Results

From the 102 patients (56 men and 48 women) 38 (37.5%) died within the first 30 days, most of them in the first 10 days. Age (OR 13.801, P < 0.04), APACHE II score (OR 1.114, P < 0.008), GCS (OR 2.158, P < 0.002), ICH score (OR 1.183, P < 0.001), FiO₂/pO₂ (OR 0.996, P < 0.009), haemodynamic instability (OR 2.340, P < 0.002), fever (OR 1.245, P < 0.002), and INR (OR 13.801, P < 0.04) were the strongest associated factors of 30-day mortality. Gender (OR 0.652, P < 0.301), prior illness (OR 1.070, P < 0.870), MODS (OR 0.978, P < 0.803), LOS (OR 0.988, P < 0.266), MV (OR 0.994, P < 0.356) and TT (OR 0.990 P < 0.371) were not associated with mortality. Patients who where operated on had higher mortality but were also more severely ill.

Conclusion

Age, severity of illness, ICH score, hypoxemia, haemodynamic instability, and increased temperature are directly related with the outcome of patients with SICH. Gender, LOS, MV, TT, and MODS did not influence mortality.