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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 Nov 06

DOI: 10.23736/S0375-9393.17.12225-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

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 Milano-Bicocca, Milan, Italy; 2 Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy; 3 Neurosurgery, Department of Neurosciences, San Gerardo Hospital, ASST-Monza, Monza, Italy


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BACKGROUND. Intracerebral hemorrhage (ICH) admitted to intensive care is deem of poor prognosis. To compare observed and predicted 30-days 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. 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- days 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-days mortality, respectively (p<0.0001 vs. ICH score). Full treatment group 180-days 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-days mortality (p=0.0005 and p=0.0268, 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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Publication History

Article first published online: November 06, 2017
Manuscript accepted: October 30, 2017
Manuscript revised: October 24, 2017
Manuscript received: June 7, 2017

Per citare questo articolo

Spina S, Marzorati C, Vargiolu A, Magni F, Riva M, Rota M, et al. Intracerebral hemorrhage in intensive care unit: early prognostication fallacies. A single center retrospective study. Minerva Anestesiol 2017 Nov 06. DOI: 10.23736/S0375-9393.17.12225-X

Corresponding author e-mail

giuseppe.citerio@unimib.it