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Abstract

Introduction: There is limited data on the impact of acute physiologic abnormalities on functional outcomes in patients with primary spontaneous intracerebral hemorrhage (ICH). The purpose of this study is to assess the impact of the APACHE IV Acute Physiology Score (APS)—a validated marker of critical illness severity—on functional outcomes in these patients. Hypothesis: We hypothesized that patients with a higher APS are more likely to be dependent as assessed by the modified Rankin Scale (mRS). Methods: We reviewed consecutive primary spontaneous ICH patients enrolled in an ongoing prospective, observational trial evaluating Magnetic Resonance Imaging characteristics of ICH. Using the APACHE Foundation’s online database, an APS was calculated for each patient on admission. The range for APS is 0 to 252, with higher values indicative of worse physiologic derangement. Blinded mRS were obtained by certified examiners at discharge or 14-days, 3-months, and 6-months. Outcomes were dichotomized with functional dependency defined as mRS > 2. Results: Amongst 65 eligible patients, 34 consented and were able to complete the study. Their mean age was 55.1 years and 52.9% were men. 61.7% were African-American. Mean ICH and FUNC Scores were 0.65 and 9.5, respectively. Mean APS score was 31.4 (STD +/- 16.3). APS was predictive of functional dependency at discharge or 14-days (OR 1.21, 95% CI 1.04-1.41, p = 0.01) and 6-months (OR 1.13, 95% CI 1.0-1.28, p = 0.04). The score approached statistical significance at 3-months (OR 1.07, 95%, CI 1.0-1.15, p = 0.054). Conclusions: Physiologic abnormalities can occur in patients with primary spontaneous ICH upon presentation to the intensive care unit. Preliminary data on our cohort of patients suggest that these abnormalities increase the odds for long-term functional dependence. Current prognostic scores that assess the severity of ICH may potentially miss the impact of other organ dysfunction on outcomes. Further data is needed on the effect of physiologic derangement on outcomes in these patients.