Independent Predictors of One-Month Mortality in Patients with Intracranial Hemorrhage; a Cohort Study


Introduction: Predicting the outcome is one of the most frequent and important issues when approaching patients with intracranial hemorrhage (ICH). Objective: This study aimed to evaluate the correlation of SUSPEKT score variables plus electrocardiogram (ECG) abnormalities with one-month mortality of patients with ICH presenting to emergency department (ED). Methods: In this cohort study, adult patients presenting to the EDs of three educational hospitals, during one year, were followed and their one-month mortality rate as well as independent predictors of outcome among the variables of SUSPEKT score plus electrocardiography findings were evaluated. Results: One hundred seventy-seven patients with the mean age of 63.07±14.89 years were studied (59.9%). The most common locations of intra-parenchymal hemorrhage were basal ganglia (53.7%) and cortex (36.2%). Ninety-two (52.0%) of cases had at least one ECG abnormality. The most frequent ECG abnormalities were ST segment depression (20.3%), T wave inversion (16.4%), and left ventricular hypertrophy (14.7%). Thirty (16.9%) cases died during the 30-day follow-up. Survived and non-survived cases were significantly different regarding the location of intra-parenchymal hemorrhage (p < 0.0001), presence of intraventricular hemorrhage (IVH) (p = 0.007), ST segment elevation (p < 0.0001), bradycardia (p < 0.0001), tachycardia (p < 0.0001), arterial fibrillation (p < 0.0001), blood sugar (p = 0.044), and serum level of potassium (p = 0.022). Conclusions: The location of hemorrhage (basal ganglia), higher blood sugar, and presence of ECG abnormalities (ST segment elevation, tachycardia, bradycardia, atrial fibrillation) were among the independent predictors of one-month mortality of ICH patients in this study.

1. Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsu F. The global stroke initiative. Lancet Neurol. 2004;3(7):391-3.
2. Truelsen T, Bonita R, Jamrozik K. Surveillance of stroke: a global perspective. Int J Epidemiol. 2001;30 Suppl 1:S11-6.
3. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355-69.
4. Adeoye O, Broderick JP. Advances in the management of intracerebral hemorrhage. Nat Rev Neurol. 2010;6(11):593-601.
5. O'donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112-23.
6. Koivunen RJ, Satopää J, Meretoja A, Strbian D, Haapaniemi E, Niemelä M, et al. Incidence, risk factors, etiology, severity and short‐term outcome of non‐traumatic intracerebral hemorrhage in young adults. Eur J Neurol. 2015;22(1):123-32.
7. Kasmaei VM, Asadi P, Zohrevandi B, Raouf MT. An epidemiologic study of traumatic brain injuries in emergency department. Emergency. 2015;3(4):141.
8. Biffi A, Anderson CD, Battey TW, Ayres AM, Greenberg SM, Viswanathan A, et al. Association between blood pressure control and risk of recurrent intracerebral hemorrhage. JAMA. 2015;314(9):904-12.
9. Khambu B, Paudel P, Bista P, Sharma R, Deo K, Rajiv J, et al. Utility of Intracerebral Hemorrhage Score for Predicting Prognostic Value in Hypertensive Bleed. Postgrad Med J NAMS. 2018;18(1):20-6.
10. Wayan N, Anne S, Tjokorda M. Combination Intracerebral Hemorrhage-graeb Score Improves Prediction of Outcome in Spontaneous Intracerebral Hemorrhage. Biomed pharmacol J. 2019;12(1):463-7.
11. Rordorf G; Mcdonald C. Spontaneous intracerebral hemorrhage: Pathogenesis, clinical features, and diagnosis. Uptodate. 2017. [Available via: https:// clinicalfeatures-and-diagnosis].
12. Szepesi R, Széll IK, Hortobágyi T, Kardos L, Nagy K, Lánczi LI, et al. New prognostic score for the prediction of 30-day outcome in spontaneous supratentorial cerebral haemorrhage. Biomed Res Int. 2015; 2015: 961085.
13. Sakr YL, Lim N, Amaral AC, Ghosn I, Carvalho FB, Renard M, et al. Relation of ECG changes to neurological outcome in patients with aneurysmal subarachnoid hemorrhage. Int J Cardiol. 2004;96(3):369-73.
14. Togha M, Sharifpour A, Ashraf H, Moghadam M, Sahraian MA. Electrocardiographic abnormalities in acute cerebrovascular events in patients with/without cardiovascular disease. Ann Indian Acad Neurol. 2013;16(1):66-71.
15. Fogelholm R, Murros K, Rissanen A, Avikainen S. Admission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study. J Neurol Neurosurg Psychiatry. 2005; 76(3):349-53.
16. Stead LG, Jain A, Bellolio MF, Odufuye A, Gilmore RM, Rabinstein A, et al. Emergency Department hyperglycemia as a predictor of early mortality and worse functional outcome after intracerebral hemorrhage. Neurocrit Care. 2010;13(1):67-74.
17. Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med. 1999;27(3):617-21.
18. Tetri S, Juvela S, Saloheimo P, Pyhtinen J, Hillbom M. Hypertension and diabetes as predictors of early death after spontaneous intracerebral hemorrhage. J Neurosurg. 2009;110(3):411-7.
19. Lee SH, Kim BJ, Bae HJ, Lee J, Lee J, Park BJ, et al. Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study. Diabetologia. 2010;53(3):429-34.
20. Nilsson OG, Lindgren A, Brandt L, Säveland H. Prediction of death in patients with primary intracerebral hemorrhage: a prospective study of a defined population. J Neurosurg. 2002;97(3):531-6.
21. Gomis M, Ois A, Rodriguez‐Campello A, Cuadrado‐Godia E, Jiménez‐Conde J, Subirana I, et al. Outcome of intracerebral haemorrhage patients pre‐treated with statins. Eur J Neurol. 2010;17(3):443-8.
22. Reinhard M, Neunhoeffer F, Gerds TA, Niesen W-D, Buttler K-J, Timmer J, et al. Secondary decline of cerebral autoregulation is associated with worse outcome after intracerebral hemorrhage. Intensive Care Med. 2010;36(2):264-71.
23. Kumar MA, Rost NS, Snider RW, Chanderraj R, Greenberg SM, Smith EE, et al. Anemia and hematoma volume in acute intracerebral hemorrhage. Crit Care Med. 2009;37(4):1442-7.
24. Ruiz-Sandoval JL, Chiquete E, Romero-Vargas S, Padilla-Martínez JJ, González-Cornejo S. Grading scale for prediction of outcome in primary intracerebral hemorrhages. Stroke. 2007;38(5):1641-4.
25. Davis S, Broderick J, Hennerici M, Brun N, Diringer M, Mayer S, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66(8):1175-81.
26. Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28(1):1-5.
27. D'Elia L, Barba G, Cappuccio FP, Strazzullo P. Potassium intake, stroke, and cardiovascular disease: a meta-analysis of prospective studies. J Am Coll Cardiol. 2011;57(10):1210-9.
28. Juvela S. Risk factors for impaired outcome after spontaneous intracerebral hemorrhage. Arch Neurol. 1995;52(12):1193-200.
29. Ziai WC, Torbey MT, Kickler TS, Oh S, Bhardwaj A, Wityk RJ. Platelet count and function in spontaneous intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2003;12(4):201-6.
30. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score. Stroke. 2001;32(4):891-7.
31. Takeuchi S, Nagatani K, Otani N, Wada K, Mori K. Electrocardiograph abnormalities in intracerebral hemorrhage. J Clin Neurosci. 2015;22(12):1959-62.
32. Levis JT. Ecg diagnosis: deep T wave inversions associated with intracranial hemorrhage. Perm J. 2017;21:16-049.
IssueVol 5 No 4 (2021): Autumn (October) QRcode
SectionOriginal article
DOI 10.18502/fem.v5i4.6690
Cohort Studies Electrocardiography Intracranial Hemorrhages Prognosis Stroke

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Kariman H, Babadi B, Raofi M, Safari S. Independent Predictors of One-Month Mortality in Patients with Intracranial Hemorrhage; a Cohort Study. Front Emerg Med. 5(4):e39.


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