Predictors of outcome in spontaneous intracerebral hemorrhage with special reference to hyponatremia

Abstract

Objective: The study was done to find the various clinical, biochemical and radiological predictors of outcome in spontaneous intracerebral hemorrhage (SICH) patients and to assess the role of hyponatremia as a predictor of in-hospital mortality. Materials and Methods: This was a hospital based prospective observational study conducted in the department of Medicine, VMMC and Safdarjang Hospital, New Delhi, India on 75 adults (>18 years of age, both male and female) presenting with SICH. Various parameters comprising demographic, clinical, laboratory, and radiological variables along with stroke severity were assessed and studied as predictors of in-hospital outcome, i.e., mortality and disability at the time of discharge as assessed by modified Rankin's Scale (mRS) in 75 SICH patients presenting to the emergency department. Furthermore, the role of hyponatremia as a predictor of in-hospital mortality was studied. Results: Out of 75 patients enrolled in the study, 40% (n = 30) of the patients died in the hospital and 60% (n = 45) were discharged. Out of the discharged category, 80% (n = 36) had mild disability with mRS 1–3 and 20% (n = 9) had moderate-to-severe disability with mRS 4-5. National Institute of Health Stroke Scale (NIHSS) at the time of hospitalization was found to be the significant independent predictor of in-hospital mortality and higher mRS score at discharge. Furthermore, Glasgow Coma Scale (GCS) ≤4 and NIHSS >12 were significantly associated with in-hospital mortality. Hyponatremia was found in 44% (n = 33) of the patients at the time of hospitalization and out of them sodium level got corrected in 15.15% (n = 5). Out of the 42 normonatremic patients 31% (n = 13) developed hyponatremia in subsequent days during hospitalization. No association was found between hyponatremia and in-hospital mortality. Conclusion: Our study highlights the fact that SICH is associated with high in-hospital mortality. NIHSS score at the time of hospitalization is an independent predictor of in-hospital mortality and disability at discharge. Furthermore, GCS ≤4 and NIHSS >12 are significantly associated with in-hospital mortality. Although hyponatremia is a common occurrence in patients with SICH, our study failed to show association between hyponatremia and in-hospital mortality.