Risk factors for impaired outcome after spontaneous intracerebral hemorrhage

S. Juvela
Department of Neurosurgery, Helsinki University Central Hospital, Finland.

OBJECTIVE: To search out independent prognostic factors, including preictal variables for outcome of spontaneous intracerebral hemorrhage. DESIGN: Prospective follow-up study. PATIENTS: One hundred fifty-six consecutive patients (96 men and 60 women) aged 16 to 60 years admitted as emergencies after bleeding. MAIN OUTCOME MEASURES: Potential risk factors (baseline characteristics, health habits, and clinical variables) for death and impaired outcome were studied prospectively up to 1 year after hemorrhage. RESULTS: One year after hemorrhage, 64 patients (41%) were independent and 34 patients (22%) were dependent in the activities of daily living; 58 patients (37%) had died. Risk of death was predicted, after adjustment for sex, age, hypertension, and body mass index, by clinical condition at admission according to the Glasgow Coma Scale (P < .001) and the occurrence of subcortical hematoma (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04 to 0.91; P = .04). Risk of poor outcome (dependent state or death) was predicted, after adjustment for sex, hypertension, body mass index, cigarette smoking, presence of intraventricular hemorrhage, and surgery, significantly by the Glasgow Coma Scale (P < .001); presence of subcortical hematoma (OR, 0.04; 95% CI, 0.01 to 0.27; P < .001); volume of hematoma (P = .03); age (P = .004); amount of alcohol consumed within 1 week before hemorrhage (P = .03); and presence of cerebellar hematoma (OR, 0.13; 95% CI, 0.02 to 0.95; P = .04). Significant independent predictors of impaired outcome (assessed with the Glasgow Outcome Scale) were the Glasgow Coma Scale (P < .001); presence of subcortical hematoma (OR, 0.26; 95% CI, 0.10 to 0.67; P = .006); alcohol intake within 1 week (P = .002); and presence of cerebellar (OR, 0.16; 95% CI, 0.04 to 0.60; P = .008), intraventricular (OR, 2.74; 95% CI, 1.19 to 6.28; P = .02), or caudate hemorrhage (OR, 0.13; 95% CI, 0.02 to 0.77; P = .03). The mean erythrocyte corpuscular volume was directly associated with an impaired outcome (P < .05). CONCLUSION: In addition to severity and location of the hemorrhage, the age of the patient and the amount of alcohol consumed within 1 week seem to be independent determinants of outcome after intracerebral hemorrhage.