title: Predictors of in-hospital mortality and prognosis in patients with large hemispheric stroke receiving decompressive craniectomy.
abstract: OBJECTIVE
  Decompressive craniectomy reduces fatality in patients with space-occupying infarctions. However, mortality remains high. We aimed to identify predictors of in-hospital mortality and outcomes in a cohort of patients with large hemispheric stroke receiving decompressive craniectomy.
  
  
  METHODS
  We retrospectively reviewed all patients diagnosed with complete middle cerebral artery infarction and receiving decompressive craniectomy. Hospital characteristics were compared among different groups (survivors versus non-survivors, good outcome versus poor outcome). A total of 71 consecutive patients were enrolled.
  
  
  RESULTS
  From 2004 January to 2010 April, 71 patients were enrolled whose mean age was 65.11 ± 13.13 years and 33 (46.5%) of these were men. The in-hospital mortality was 28.2% overall. Of the patients who survived and were discharged, 37 (77.1%) had poor outcome (mRS 4-6) and 11 (22.9%) had good outcome (mRS 0-3). Pre-operation brain computed tomography (CT) hypodensity volume (p = 0.001) was significantly associated with mortality. In binary logistic regression model, pre-operation brain CT hypodensity volume (OR = 1.015; 95% CI, 1.001 to 1.030) and age (OR = 1.112; 95% CI, 1.017 to 1.215) were both significantly associated with outcomes.
  
  
  CONCLUSIONS
  In patients with large hemispheric stroke receiving decompressive craniectomy, pre-operation brain CT hypodensity volume was significantly associated with in-hospital mortality whereas age was not. Pre-operation brain CT hypodensity volume and age were predictors of outcomes in those who survived the acute phase.
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Poyin
authors.initials: P
authors.lastname: Huang
authors.forename: Feng-Cheng
authors.initials: FC
authors.lastname: Lin
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Su
authors.forename: Gim-Thean
authors.initials: GT
authors.lastname: Khor
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Ruey-Tay
authors.initials: RT
authors.lastname: Lin
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000401:mortality; D056424:Decompressive Craniectomy / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome