title: A prospective study of in-hospital mortality and discharge outcome in spontaneous intracerebral hemorrhage.
abstract: BACKGROUND
  Intracerebral hemorrhage (ICH) is associated with high mortality and morbidity. Various clinical and imaging predictors of mortality have been observed in previous studies.
  
  
  OBJECTIVE
  To study factors associated with in-hospital mortality in patients with ICH and observe the disability status of patients [assessed by modified Rankin scale (mRS)] at the time of discharge.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  All consecutive patients with acute hypertensive ICH admitted during the study period were enrolled. Data recorded included: Demographics, clinical, biochemical and cranial computed tomography (CT) findings. Primary outcome was defined as either death or survival within the hospital. mRS was used to assess outcome at discharge.
  
  
  RESULTS
  Of the total 214 patients with ICH (193 supratentorial and 21 infratentorial), 70 (32.7%) patients died during the hospital stay. On bivariate analysis, low Glasgow Coma Scale (GCS) score, ventilatory assistance, higher hematoma volume, midline shift, hydrocephalus and intraventricular hematoma (IVH) were associated with mortality. ICH grading scale (ICH-GS) and ICH scores were higher in patients who died (P < 0.0001). Ninety-five (44.6%) patients underwent a neurosurgical intervention; 66 (45.8%) patients among the survivors compared with 29 (41.4%) among those who died (P = 0.54, Odds Ratio (OR) 0.83, 95% Confidence Interval (CI) 0.46-1.48). Independent predictors of mortality included a higher baseline hematoma volume ( P = 0.04 OR 1.01, 95% CI 1.00-1.02), lower GCS ( P = 0.01 OR 2.57, 95%CI 1.25-5.29), intraventricular extension of hematoma ( P = 0.007 OR 2.66, 95% CI 1.26-5.56) and ventilatory requirement (P < 0.0001 OR 8.34, 95%CI 2.75-25.38). Among survivors (n = 144), most were disabled [mRS 0-3, 7 (4.8%) and mRS 4-5, 137 (95.13%)] at discharge.
  
  
  CONCLUSIONS
  Low GCS, higher baseline ICH volume, presence of IVH and need for ventilatory assistance are independent predictors of mortality. Most of the patients at discharge were disabled. Surgery did not improve mortality or outcome.
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. rohitbhatia71@yahoo.com
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhatia
authors.forename: Hariom
authors.initials: H
authors.lastname: Singh
authors.forename: Shaily
authors.initials: S
authors.lastname: Singh
authors.forename: Madakasira V
authors.initials: MV
authors.lastname: Padma
authors.forename: Kameshwar
authors.initials: K
authors.lastname: Prasad
authors.forename: Manjari
authors.initials: M
authors.lastname: Tripathi
authors.forename: Guresh
authors.initials: G
authors.lastname: Kumar
authors.forename: Mamta Bhushan
authors.initials: MB
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000150:complications / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome