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Minerva Anestesiologica 2018 May;84(5):572-81

DOI: 10.23736/S0375-9393.17.12225-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Intracerebral hemorrhage in Intensive Care Unit: early prognostication fallacies. A single center retrospective study

Stefano SPINA 1, Chiara MARZORATI 1, Alessia VARGIOLU 2, Federico MAGNI 1, Matteo RIVA 1, Matteo ROTA 2, Carlo GIUSSANI 1, 3, Erik P. SGANZERLA 1, 3, Giuseppe CITERIO 1, 2

1 School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; 2 Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy; 3 Unit of Neurosurgery, Department of Neurosciences, San Gerardo Hospital, ASST-Monza, Italy


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BACKGROUND: Intracerebral hemorrhage (ICH) admitted to Intensive Care is deem of poor prognosis. The aim of this study was to compare observed and predicted 30-day mortality and to evaluate long term functional outcome in a consecutive ICH cohort.
METHODS: Retrospective analysis of prospectively collected data of ICH patients managed in a Neuro-ICU from 2012 to 2015.
RESULTS: Out of 136 consecutive patients, 34 (25%) had “withholding of life-sustaining treatment” (WLST) order and 102 (75%) received a “full treatment” (FT). WLST cohort: median (IQR): 72 (70-77) years old, Glasgow Coma Scale (GCS) 4 (3-4) at admission, ICH volume 114 cm3 (68-152); all patients died during neuro-ICU recovery, 28 (82%) patients had brain death diagnosis and 15 (54%) of these were organ donors. FT cohort: 67 (51-73) years old, GCS 9 (6-12) at admission, ICH volume 46 (24-90) cm3, neurosurgery for clot removal in 65 (64%) (P<0.05 vs. WLST cohort for each of previously listed variables); 13 (13%) patients died during neuro-ICU recovery, of these 11 (85%) patients had brain death diagnosis and 4 (36%) of them were organ donors. Overall 30-day observed mortality for FT group was 18% (95% CI: 11-26%). Patients with ICH Score 1, 2, 3, 4+ had 0%, 10%, 16% and 26% 30-day mortality, respectively (P<0.01 vs. ICH Score). Full treatment group 180-day mortality was 32% (95% CI: 24-42%). Modified Rankin Scale (mRS) after one year was ≤3 in 35 (35%), i.e. good recovery, and >3 in 64 (65%). Neurosurgery for clot removal was associated with a lower 30 and 180-day mortality (P=0.01 and P=0.03, respectively) and along with GCS at admission it was an independent significant prognostic factor.
CONCLUSIONS: Mortality and functional outcome is less severe than predicted in patients with ICH receiving a full medical and/or surgical treatment.


KEY WORDS: Cerebral hemorrhage - Prognosis - Mortality - Critical care outcomes - Disability evaluation - Neurosurgery

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