gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Early predictors of good functional outcome in patients with intracerebral haemorrhage and fibrinolytic therapy

Frühe Prädiktoren zur Vorhersage eines guten, funktionellen Outcomes bei Patienten mit intrazerebraler Blutung und fibrinolytischer Therapie

Meeting Abstract

  • presenting/speaker Christina Wolfert - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Bogdan Iliev - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland; Westpfalz-Klinikum, Neurochirurgie, Kaiserslautern, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Vesna Malinova - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP088

doi: 10.3205/20dgnc375, urn:nbn:de:0183-20dgnc3756

Veröffentlicht: 26. Juni 2020

© 2020 Wolfert et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Minimally invasive surgery with neuronavigated intrahematomal catheter placement and subsequent application of recombinant tissue Plasminogen Activator (rtPA) facilitates a faster hematoma resolution. The assessment of early predictors for achieving a good functional outcome is of great clinical relevance and could be supportive during the decision-making process for further therapy. In this study we aimed to evaluate early predictors of good functional outcome in ICH-patients, who survived the acute phase after the acute incident.

Methods: We performed a retrospective analysis of patients with supratentorial ICH back to 2010. The following factors were included: age, arterial hypertension (aHT), diabetes mellitus (DM), serum glucose (GLU) and Glasgow coma scale (GCS) at admission, initial hydrocephalus (HC), anticoagulation (AC), duration of sedation (DoS), duration of ventilation (DoV), duration of intensive care unit stay (ICU-stay) and intraventricular hemorrhage (IVH). Volumetric analysis of initial ICH volume and volume after every dose of rtPA was performed (brainlab).The functional outcome was calculated according to the modified Rankin scale (mRS), whereas mRS≤3 was considered as good functional outcome.

Results: A total of 100 patients (54%; n=54 male) with mean age 65.8 years (range: 30-93 years), were enrolled. Mean initial ICH volume was 51.5 mL (range: 19-108 mL), with deep-seated ICH in 58% (n=58). The mean administered rtPA dose was 10.8 mg rtPA (range: 3.0-22.0 mg) in up to 5 single doses. Good functional outcome was achieved by 7 patients (7%). Most patients (n=74, 74%) had mRS 4. DM (p=0.75), sex (p=0.70), quantity of lysis (p=0.64), aHT (p=0.22), initial ICH volume (p=0.16), localization of the bleeding (p=0.15), infections (p=0.11), intraventricular bleeding (p=0.10) and GCS at admission (p=0.066) reached no significance for the prediction of functional outcome. In contrast to that, HC (p=0.026), GLU (p=0.018) and residual volume after second rtPA dose (p=0.005) were significant predictors of functional outcome.

Conclusion: Good functional outcome is still rarely achieved by ICH-patients. Unexpectedly, initial GCS and preexisting comorbidities were not predictive of functional outcome after ICH. The achievement ofa smaller residual ICH-Volume within the first 48 hours after onset of hemorrhage seems to be a relevant goal of fibrinolytic therapy, which might lead to a better functional outcome after ICH.