Abstract WP459: The Impact of Patient Demographics and Comorbidities on Inpatient Mortality After Intracerebral Hemorrhage

Abstract

Objective: To observe for trends in the inpatient mortality rate following nontraumatic intracerebral hemorrhage (ICH) and to determine the effect of pertinent comorbidities on inpatient mortality using the US National Inpatient Sample (NIS) database. Method: Using the NIS (2012-first three quarter of 2015) database, patient records of adults with ICH were analyzed. We extracted data with a principal diagnosis of ICH using the diagnostic code 431 (ICD-9-CM) and clinical classifications software code 109 (acute cerebrovascular disease) so that traumatic ICH cases were eliminated. Results: A total number of 47,700 patients were included in this study. The mean age was 68 years. The majority of the patients ranged in age from 51 to 75 years (49%), were male (52%) and Caucasian (60%). Weekend admissions made up 27% of cases. Pertinent comorbidities noted in this cohort include coagulopathy (8%), diabetes (28%), hypertension (84%), liver disease (3%), renal failure (14%) and obesity (9%). The overall inpatient mortality rate was 24%. The mortality rate was high in females (25%) vs males (23%, p< 0.001); underlying coagulopathy (29% vs 24% without, p< 0.001) and liver disease (27% vs 24% without, p=0.019). Mortality rate was also elevated in patients >75 years old (28%, p< 0.001). There was no association between inpatient mortality rate and median household income, or the presence of diabetes or renal failure. It was significantly low with hypertension (23% vs 29%, p< 0.001) and obesity (17% vs 25%, p< 0.001). When the group of ICH patients without hypertension was compared with the hypertensive group we found a significantly higher proportion of patients with coagulopathy (11% vs 8%) and liver disease (5% vs 3%). However obesity did not confer a significant risk of comorbid coagulopathy (8% vs 8%) or liver disease (2.9% vs 3.1%). Conclusion: The overall observed inpatient mortality rate in this study of patients admitted for nontraumatic ICH was 24%. Comorbidities which increased the mortality rate significantly were female gender, age greater than 75 years, coagulopathy and liver disease. It was significantly low in hypertension and in obesity. The paradoxical effect of hypertension and obesity on inpatient mortality needs to be further assessed in prospective studies.