Article
Survival analysis and identification of prognostic factors after spontaneous supratentorial intracerebral haemorrhage – a retrospective cohort study
Analyse der prognostischen Faktoren im Bezug auf das Hämatomvolumen für die Mortalität nach spontanen supratentoriellen intrazerebralen Blutungen
Search Medline for
Authors
-
Panagiotis Fistouris
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
-
Mateo Tomas Farina Nunez
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
-
Ralf Watzlawick
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
-
Jürgen Beck
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
-
Christian Fung
- Medical Center, University of Freiburg, Department of Neurosurgery, Freiburg, Deutschland
| Published: | June 4, 2021 |
|---|
Outline
Text
Objective: Supratentorial spontaneous intracerebral hemorrhage (sICH) remains associated with persistently high mortality and morbidity rates. A variety of risk factors influence the neurological outcome and survival of these patients. The impact of these factors may vary depending on the size of the hematoma. In this retrospective study, we investigated the impact on overall survival of these risk factors subject to hematoma size.
Methods: A retrospective cohort analysis of patients with sICH treated in our department from 2010 to 2012 was carried out. Depending on their initial hematoma volume, all participants were divided into subgroups of hematoma volume ≤50cc or > 50cc. Cumulative and volume-group-stratified short and long-term survival analysis was performed to evaluate the survival probability and hazard ratios for death. Uni- and multivariate cox proportional regression models were used to estimate the different covariates’ odds ratios.
Results: Nearly a quarter of all patients (24.07%) died during their initial stay in the hospital. Hematomas larger than 50 cc showed a significantly higher mortality rate (log-rank test p<0.0001). A multivariate regression analysis revealed the patients’ age as the decisive factor for the prediction in the case of hematomas smaller than 50 cc (hazard ratio=13.1, 95% CI: 1.84 - 92.99, p=0.01). Radiographic signs of a cerebral herniation (p=0.004, hazard ratio= 14.71, 95% CI: 2.35 - 91.90) and mydriasis (p=0.04, hazard ratio=6.96, 95% CI: 1.02 - 47.4) have influenced the prognosis of larger hematomas. The long-term survival time of hematomas smaller than 50 cc was 70 months and was predominantly influenced by age and patient comorbidities. In hematomas larger than 50cc, median survival was reduced to 17 months, and their prognosis was correlated with the Glasgow Coma Scale score at the time of hospital discharge.
Conclusion: In larger than 50cc hematomas, the prognosis for in-hospital mortality is mainly influenced by the mass effect of the bleeding, especially in the presence of cerebral herniation. Their long-term prognosis is correlated with GCS at the time of hospital discharge. Patient comorbidities and age have a strong influence on the prognosis of smaller than 50 cc hematomas.
