Abstract
Background. This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (n = 190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3−month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0−3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4−5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (p = <0.001, OR 4.806, 95% CI 3.064–7.54), admission GCS <8 (p = <0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml (p = <0.001, OR 2.45, 95% CI 1.626–3.691). Intraventricular haemorrhage was an additional poor outcome predictor (p < 0.015, CI 1.105–2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.
Highlights
Spontaneous Intracerebral Haemorrhage (SICH) is the second most common cause of stroke and accounts for 7.5−30% of all strokes [1, 2]
One-fi h of the patients regain functional independence a er SICH and between one-fourth to half of the patients succumb to the bleed [1, 6]
In developing countries like India with severe resource constraints, treatment strategies need to be customised given the high morbidity and mortality associated with SICH
Summary
Spontaneous Intracerebral Haemorrhage (SICH) is the second most common cause of stroke and accounts for 7.5−30% of all strokes [1, 2]. Haemorrhagic stroke is generally associated with higher morbidity and mortality rates than ischemic stroke [3,4,5]. One-fi h of the patients regain functional independence a er SICH and between one-fourth to half of the patients succumb to the bleed [1, 6]. In developing countries like India with severe resource constraints, treatment strategies need to be customised given the high morbidity and mortality associated with SICH. E goal of this single institution based study was to analyse the clinical profile, to assess the functional outcome and to identify the outcome prognosticators a er SICH in a tertiary care hospital located in a coastal town in South India Published literature from India on outcome following SICH is limited [8,9,10,11,12,13,14,15,16,17,18]. e goal of this single institution based study was to analyse the clinical profile, to assess the functional outcome and to identify the outcome prognosticators a er SICH in a tertiary care hospital located in a coastal town in South India
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