Mortality, Functional Status, and Quality of Life after 5 Years of Patients Admitted to Critical Care for Spontaneous Intracerebral Hemorrhage.

Abstract

The objective of this study was to assess long-term outcome in patients with spontaneous intracerebral hemorrhage admitted to the intensive care unit. Mortality and Glasgow Outcome Scale, Barthel Index, and5-level EQ-5D version (EQ-5D-5L) scores were analyzed in a multicenter cohort study of three Spanish hospitals (336 patients). Mortality was also analyzed in theMedical Information Mart for Intensive Care III (MIMIC-III) database. The median(25th percentile-75th percentile) age was 62 (50-70) years, the median Glasgow Coma Score was 7 (4-11) points, and the median Acute Physiology and Chronic Health disease Classification System II(APACHE-II) score was 21 (15-26) points. Hospital mortality was 54.17%, mortality at 90days was 56%, mortality at 1year was 59.2%, and mortality at 5years was 66.4%. In the Glasgow Outcome Scale, a normal or disabled self-sufficient situation was recorded in 21.5% of patients at 6months, in 25.5% of patients after 1year, and in 22.1% of patients after 5years of follow-up (4.5% missing). The Barthel Index score of survivors improved over time: 50 (25-80) points at 6months, 70 (35-95) points at 1year, and 90 (40-100) points at 5years (p < 0.001). Quality of life evaluated with the EQ-5D-5L at 1year and 5years indicated that greater than 50% of patients had no problems or slight problems in all items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). In the MIMIC-III study (N = 1354), hospital mortality was 31.83% and was 40.5% at 90days and 56.2% after 5years. In patients admitted to the intensive care unit with a diagnosis of nontraumatic intracerebral hemorrhage, hospital mortality up to 90days after admission is very high. Between 90days and 5years after admission, mortality is not high. A large percentage of survivors presented a significant deficit in quality of life and functional status, although with progressive improvement over time. Five years after the hemorrhagic stroke, a survival of 30% was observed, with a good functional status seen in 20% of patients who had been admitted to the hospital.