Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 27 , ISSUE 12 ( December, 2023 ) > List of Articles

Original Article

Unveiling the Crystal Ball: Predictors of Adverse Outcomes in Intracerebral Hemorrhage Patients

Awatif K Alsarrai Al-Alawi, Darpanarayan Hazra, Mohammed Jumaiel Khalfan Al-Hassani, Amjad Said Abdullah Al-Jamoudi

Keywords : Cerebrovascular accident, Emergency room, Intracerebral hemorrhage, Poor outcome, Stroke

Citation Information : Al-Alawi AK, Hazra D, Al-Hassani MJ, Al-Jamoudi AS. Unveiling the Crystal Ball: Predictors of Adverse Outcomes in Intracerebral Hemorrhage Patients. Indian J Crit Care Med 2023; 27 (12):895-901.

DOI: 10.5005/jp-journals-10071-24578

License: CC BY-NC 4.0

Published Online: 30-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: Intracerebral hemorrhage (ICH) is a severe form of stroke with substantial morbidity and mortality worldwide. Despite its impact, research has often focused on ischemic strokes, making ICH an essential area to explore. Methods: A retrospective cohort study spanning 5 years was conducted in an Oman-based tertiary care teaching hospital's emergency room. Data from patients diagnosed with spontaneous ICH, confirmed by cranial CT scans, were analyzed. Ethical approval was obtained. Results: Among 163 emergency room (ER)-presented patients with ICH, 89 met the inclusion criteria. Most were male (69.66%), with hypertension (69/89) and diabetes mellitus (43/89) being common comorbidities. Hematoma size was a crucial predictor of poor outcomes, especially for larger hematomas (>60 cm3). Midline shift, intraventricular hemorrhages, elevated systolic and diastolic blood pressure, and low Glasgow Coma Scale (GCS) scores were significantly associated with unfavorable outcomes. However, variables such as age, gender, history of heart disease, hypertension, diabetes, and anticoagulant use did not show significant associations with disability outcomes. Favorable outcomes (mRS <3) were observed in 47.2% of patients, while 30.3% had a major disability (mRS 3–5), and 22.5% succumbed to their illness (mRS 6). Conclusion: This study enhances our understanding of ICH outcomes, highlighting the importance of hematoma size, midline shift, intraventricular hemorrhage, blood pressure control, and GCS scores in predicting disability. Future research could explore additional prognostic factors and interventions for ICH patients.

HTML PDF Share
  1. Fernando SM, Qureshi D, Talarico R, Tanuseputro P, Dowlatshahi D, Sood MM, et al. Intracerebral hemorrhage incidence, mortality, and association with oral anticoagulation use. Stroke 2021;52(5): 1673–1681. DOI: 10.1161/STROKEAHA.120.032550.
  2. An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: An update. J Stroke 2017;19(1):3–10. DOI: 10.5853/jos.2016.00864.
  3. Caceres JA, Goldstein JN. Intracranial hemorrhage. Emerg Med Clin North Am 2012;30(3):771–794. DOI: 10.1016/j.emc.2012.06.003.
  4. Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke 2022;53(7):e282–e361. DOI: 10.1161/STR.0000000000000407.
  5. Montaño A, Hanley DF, Hemphill JC. Hemorrhagic stroke. Handb Clin Neurol 2021;176:229–248. DOI: 10.1016/B978-0-444-64034-5.00019-5.
  6. Unnithan AKA, Das JM, Mehta P. Hemorrhagic stroke. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559173/.
  7. Radu RA, Terecoasa EO, Tiu C, Ghita C, Purcaru LI, Marinescu AN, et al. Clinical characteristics and outcomes of patients with intracerebral hemorrhage – A feasibility study on Romanian patients. J Med Life 2020;13(2):125–131. DOI: 10.25122/jml-2020-0042.
  8. Faigle R, Marsh EB, Llinas RH, Urrutia VC, Gottesman RF. Race-specific predictors of mortality in intracerebral hemorrhage: Differential impacts of intraventricular hemorrhage and age among blacks and whites. J Am Heart Assoc 5(8):e003540. DOI: 10.1161/JAHA.116.003540.
  9. Gregório T, Pipa S, Cavaleiro P, Atanásio G, Albuquerque I, Chaves PC, et al. Prognostic models for intracerebral hemorrhage: Systematic review and meta-analysis. BMC Med Res Methodol 2018;18(1):145. DOI: 10.1186/s12874-018-0613-8.
  10. Hsieh JT, Ang BT, Ng YP, Allen JC, King NKK. Comparison of gender differences in intracerebral hemorrhage in a multi-ethnic Asian population. PLoS One 2016;11(4):e0152945. DOI: 10.1371/journal.pone.0152945.
  11. Craen A, Mangal R, Stead TG, Ganti L. Gender differences in outcomes after non-traumatic intracerebral hemorrhage. Cureus 11(10):e5818. DOI: 10.7759/cureus.5818.
  12. Canadian Stroke Best Practices. Emergency Management of Intracerebral Hemorrhage. Available from: https://www.strokebestpractices.ca/en/recommendations/management-of-intracerebral-hemorrhage/emergency-management-of-intracerebral-hemorrhage/.
  13. Sporns PB, Psychogios MN, Boulouis G, Charidimou A, Li Q, Fainardi E, et al. Neuroimaging of acute intracerebral hemorrhage. J Clin Med 2021;10(5):1086. DOI: 10.3390/jcm10051086.
  14. Rindler RS, Allen JW, Barrow JW, Pradilla G, Barrow DL. Neuroimaging of intracerebral hemorrhage. Neurosurgery 2020;86(5):E414–E423. DOI: 10.1093/neuros/nyaa029.
  15. Bhargava R. CT imaging in neurocritical care. Indian J Crit Care Med 2019;23(Suppl 2):S98–S103. DOI: 10.5005/jp-journals-10071-23185.
  16. Patra A, Janu A, Sahu A. MR imaging in neurocritical care. Indian J Crit Care Med 2019;23(Suppl 2):S104–S114. DOI: 10.5005/jp-journals-10071-23186.
  17. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 1993;24(7):987–993. DOI: 10.1161/01.str.24.7.987.
  18. Fang HY, Lin CY, Ko WJ. Hematology and coagulation parameters predict outcome in Taiwanese patients with spontaneous intracerebral hemorrhage. Eur J Neurol 2005;12(3):226–232. DOI: 10.1111/j.1468-1331.2004.01018.x.
  19. Lin CY, Chang CY, Sun CH, Li TY, Chen LC, Chang ST, et al. Platelet count and early outcome in patients with spontaneous cerebellar hemorrhage: A retrospective study. PLoS One 2015;10(3):e0119109. DOI: 10.1371/journal.pone.0119109.
  20. Lee SH, Kim BJ, Bae HJ, Lee JS, Lee J, Park BJ, et al. Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: The acute brain bleeding analysis study. Diabetologia 2010;53(3):429–434. DOI: 10.1007/s00125-009-1617-z.
  21. Saxena A, Anderson CS, Wang X, Sato S, Arima H, Chan E, et al. Prognostic significance of hyperglycemia in acute intracerebral hemorrhage. Stroke 2016;47(3):682–688. DOI: 10.1161/STROKEAHA.115.011627.
  22. Mazzoleni V, Padovani A, Morotti A. Emergency management of intracerebral hemorrhage. J Crit Care 2023;74:154232. DOI: 10.1016/j.jcrc.2022.154232.
  23. Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials | Stroke; 2023. Available from: https://www.ahajournals.org/doi/10.1161/01.str.0000258355.23810.c6.
  24. Standardized Nomenclature for Modified Rankin Scale Global Disability Outcomes: Consensus Recommendations From Stroke Therapy Academic Industry Roundtable XI | Stroke; 2023. Available from: https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.121.034480.
  25. Brott T, Thalinger K, Hertzberg V. Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 1986;17(6):1078–1083. DOI: 10.1161/01.str.17.6.1078.
  26. Walsh KB, Woo D, Sekar P, Osborne J, Moomaw CJ, Langefeld CD, et al. Untreated hypertension: A powerful risk factor for lobar and nonlobar intracerebral hemorrhage in whites, blacks, and hispanics. Circulation 2016;134(19):1444–1452. DOI: 10.1161/CIRCULATIONAHA. 116.024073.
  27. Nawabi J, Elsayed S, Morotti A, Speth A, Liu M, Kniep H, et al. Perihematomal edema and clinical outcome in intracerebral hemorrhage related to different oral anticoagulants. J Clin Med 2021;10(11):2234. DOI: 10.3390/jcm10112234.
  28. Xian Y, Zhang S, Inohara T, Grau-Sepulveda M, Matsouaka RA, Peterson ED, et al. Clinical characteristics and outcomes associated with oral anticoagulant use among patients hospitalized with intracerebral hemorrhage. JAMA Netw Open 2021;4(2):e2037438. DOI: 10.1001/jamanetworkopen.2020.37438.
  29. Murthy SB, Biffi A, Falcone GJ, Sansing LH, Torres Lopez V, Navi BB, et al. Antiplatelet therapy after spontaneous intracerebral hemorrhage and functional outcomes. Stroke 2019;50(11):3057–3063. DOI: 10.1161/STROKEAHA.119.025972.
  30. Li Y-G, Lip GYH. Anticoagulation resumption after intracerebral hemorrhage. Curr Atheroscler Rep 2018;20(7):32. DOI: 10.1007/s11883-018-0733-y.
  31. Chen S, Zhao B, Wang W, Shi L, Reis C, Zhang J. Predictors of hematoma expansion predictors after intracerebral hemorrhage. Oncotarget 2017;8(51):89348–89363. DOI: 10.18632/oncotarget.19366.
  32. Li Z, You M, Long C, Bi R, Xu H, He Q, et al. Hematoma expansion in intracerebral hemorrhage: An update on prediction and treatment. Front Neurol 2020;11:702. DOI: 10.3389/fneur.2020.00702.
  33. Teo KC, Fong SM, Leung WCY, Leung IYH, Wong YK, Choi OMY, et al. Location-specific hematoma volume cutoff and clinical outcomes in intracerebral hemorrhage. Stroke 2023;54(6):1548–1557. DOI: 10.1161/STROKEAHA.122.041246.
  34. Chen Y, Chen S, Chang J, Wei J, Feng M, Wang R. Perihematomal edema after intracerebral hemorrhage: An update on pathogenesis, risk factors, and therapeutic advances. Front Immunol 2021;12:740632. DOI: 10.3389/fimmu.2021.740632.
  35. Gupta M, Verma R, Parihar A, Garg RK, Singh MK, Malhotra HS. Perihematomal edema as predictor of outcome in spontaneous intracerebral hemorrhage. J Neurosci Rural Pract 2014;5(1):48–54. DOI: 10.4103/0976-3147.127873.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.