Clinical profile and predictors of outcome in spontaneous intracerebral hemorrhage from a tertiary care centre in south India

Hegde, Ajay and Menon, Girish and Kumar, Vinod and Prasad, Lakshmi G and Kongwad, Lakshman I and Nair, Rajesh and Nayak, Raghavendra (2020) Clinical profile and predictors of outcome in spontaneous intracerebral hemorrhage from a tertiary care centre in south India. Stroke Research and Treatment. pp. 1-8. ISSN 2090-8105

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Abstract

Background. �is article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. �e study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. �e variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10±12.76 years. �e study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (� = 190 ) were on irregular medication. �e most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. �e mean volume of the clot on admission was 23.45±19.79ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3−month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0−3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4−5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (� =< 0.001, OR 4.806, 95% CI 3.064–7.54), admission GCS <8 (� =< 0.001, OR7.684, 95% CI 5.055–11.68), and Hematoma volume >30ml (� = 0.001, OR 2.45, 95% CI 1.626–3.691). Intraventricular haemorrhage was an additional poor outcome predictor (� < 0.015, CI 1.105–2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome a�er SICH using novel predictors, including biomarkers.

Item Type: Article
Subjects: Medicine > KMC Manipal > Neuro Surgery
Depositing User: KMC Library
Date Deposited: 15 Oct 2020 04:13
Last Modified: 15 Oct 2020 04:13
URI: http://eprints.manipal.edu/id/eprint/155868

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