Association between critical care admission and 6-month functional outcome after spontaneous intracerebral haemorrhage

Abstract

BackgroundThere is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH). PurposeWe investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome. MethodsWe included 825 patients with acute spontaneous non-traumatic ICH, recruited to a prospective multicenter observational study. We evaluated the characteristics associated with critical care admission and poor 6-month functional outcome (modified Rankin Scale, mRS > 3) using univariable (chi-square test and Wilcoxon rank-sum test, as appropriate) and multivariable analysis. Results286 patients (38.2%) had poor 6-month functional outcome. Seventy-seven (9.3%) patients were admitted to critical care. Patients admitted to critical care were younger (p < 0.001), had lower GCS score (p < 0.001), larger ICH volume (p < 0.001), more often had intraventricular extension (p = 0.008) and underwent neurosurgery (p < 0.001). Critical care admission was associated with poor functional outcome at 6 months (39/77 [50.7%] vs 286/748 [38.2%]; p = 0.034); adjusted OR 2.43 [95%CI 1.36–4.35], p = 0.003), but not with death (OR 1.29 [95%CI 0.71–2.35; p = 0.4). In ordinal logistic regression, patients admitted to critical care showed an OR 1.47 (95% CI 0.98–2.20; p = 0.07) for a shift in the 6-month modified Rankin Scale. ConclusionsAdmission to critical care is associated with poor 6-month functional outcome after spontaneous ICH but not with death. Patients admitted to critical care were a priori more severely affected. Although adjusted for main known predictors of poor outcome, our findings could still be confounded by unmeasured factors. Establishing the true effectiveness of critical care after ICH requires a randomised trial with clinical outcomes and quality of life assessments.