Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages.
OBJECTIVE
To determine potential predictors of good outcome in primary medium to large intracerebral haemorrhages (ICH) which could be useful for selecting patients for surgical procedures.


METHODS
Subjects were 138 patients with spontaneous hemispheric ICH >20 ml. They were non-surgically treated and were admitted consecutively to 15 hospitals within the first 12 hours of symptom onset (mean (SD), 5.8 (3.1) hours). Haematoma volume was measured on computed tomography (CT) at admission. Stroke severity was assessed by the Canadian stroke scale (CSS). Good outcome was defined as modified Rankin score < or =2 at three months.


RESULTS
At the end of the follow up period, 45 patients (32.6%) had good outcome. Baseline stroke severity, systolic and diastolic blood pressure, body temperature, and acute phase reaction biochemical markers (ESR, C-reactive protein, fibrinogen, neutrophil count) were significantly associated with good outcome in bivariate analyses. Of the initial CT scan variables, intraventricular contamination, deep location, mass effect, and greater ICH volume were related to poor outcome. On multiple logistic regression analysis, cortical location of bleeding (odds ratio 3.79 (95% confidence interval 1.2 to 12.01); p = 0.023), high CSS score (OR 2.3 (1.6 to 3.1); p<0.0001), and low fibrinogen concentrations (OR 0.92 (0.87 to 0.97); p = 0.001) were independent predictors of good outcome. These three factors correctly classified 85% of patients.


CONCLUSIONS
Good outcome in medium to large ICH can be predicted on admission by three readily assessable factors (CSS score, ICH location, and fibrinogen levels). These predictors may be helpful in selecting patients for surgical treatment.
Castellanos
M
M
Department of Neurology, Hospital Clínico Universitario Santiago de Compostela, Travesa da Choupana s/n, Santiago de Compostela 15706, Spain.
Leira
R
R
Tejada
J
J
Gil-Peralta
A
A
Dávalos
A
A
Castillo
J
J
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000378:metabolism / Q000601:surgery*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000209:etiology / Q000378:metabolism; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D009504:Neutrophils / Q000378:metabolism; D018579:Patient Selection; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000378:metabolism / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005340:Fibrinogen; D002097:C-Reactive Protein