gms | German Medical Science

Objective: Stroke is the second leading cause of death worldwide. Intracerebral hemorrhage (ICH) accounts for 8-18% of all strokes and is associated with high mortality rates. Secondary complications after ICH can worsen outcome and may be associated with early death. The purpose of the present study was to determine mortality rates and secondary complications after spontaneous ICH in central Germany.

Method: A quality assessment database of the State of Hesse, Germany, was screened for all patients with the primary diagnosis of spontaneous ICH (ICD-10: I61.0 - I61.9) between January 2007 and December 2012. The relation between secondary complications and mortality was evaluated by univariate and multivariate statistical analysis.

Results: In the examined time period 10029 patients with spontaneous ICH were identified. The cumulative rate of secondary complications was 40.4%. 1, 2, 3, or ≥4 complications were documented in 25.1%, 10.3%, 3.3%, and 1.7%, respectively. The most common secondary complications were pneumonia (15.1%), high intracranial pressure (6.5%), cardial decompensation (5.9%), urogenital infection (5.5%), rebleeding (4.9%), and hydrocephalus (4.6%). Overall mortality was 23.2%. In patients with 1 or ≥2 complications the mortality rate was significantly increased (p<0.001) to 30.4% and 40.3%, respectively.

Surgical treatment of the hematoma was documented in 1012 patients (10.1%). Despite a higher rate of secondary complications (61.0% vs. 38.1; %; p<0.001), surgically treated patients had a lower mortality rate compared to conservatively treated patients (11.6% vs. 24.5%; p<0.001).

Conclusions: Patients with secondary complications after ICH had a higher risk of dying during their hospital stay compared to patients without secondary complications. Surgical treatment of hematomas is associated with an increased rate of secondary complications, but not with higher mortality rates compared to conservatively treated patients.