The following is a summary of “Impact of intensive medical and surgical support on Functional outcomes and Mortality in patients with Intracerebral hemorrhage,” published in the May 2023 issue of Neurology by Abulhasan, et al.

Despite advances in neurocritical care, patient outcomes after spontaneous intracerebral hemorrhage (ICH) remained poor. It was unclear whether it was due to therapeutic pessimism or the impact of the primary injury. For a contemporary cohort study, researchers aimed to evaluate 30-day and 90-day mortality, cause-specific mortality, functional outcomes, and the effect of surgical intervention in a setting of aggressive medical and surgical support.

The retrospective cohort study included consecutive adult patients with spontaneous ICH admitted to a tertiary neurocritical care unit. Patients with secondary ICH and care limitations within 72 hours were excluded. Mortality at 30 and 90 days and modified Rankin Scale (mRS) score at 1 year were examined for each ICH score. In addition, the impact of craniotomy/craniectomy ± hematoma evacuation on outcomes in supratentorial ICH was assessed using propensity score matching. Patient follow-up after discharge had a median duration of 2.2 years (interquartile range [IQR] 0.4–4.4).

The study included 319 patients with spontaneous ICH, with a median age of 69 years (IQR 60–77), and 60% of the patients were male. The 30-day and 90-day mortality rates were 16% and 22%, respectively. At a median of 3.1 months after ICH, 50% of patients had an unfavorable functional outcome (mRS score 4–6). Admission predictors of mortality aligned with the original ICH score. Unfavorable outcomes were observed in 73% and 86% of patients with ICH scores 3 and 4, respectively. The primary causes of mortality were determined to be the direct effect or progression of ICH (54%), refractory cerebral edema (21%), and medical complications (11%). The analysis of matched data showed that lifesaving surgery for supratentorial ICH did not significantly affect mortality or unfavorable functional outcomes in the overall patient population. However, subgroup analyses focusing on surgery with hematoma evacuation and patients with ICH scores 3 and 4 revealed a 71% (odds ratio [OR] 0.29, 95% CI 0.09–0.9, P = 0.032) and 80% (OR 0.2, 95% CI 0.04–0.91, P = 0.038) reduction in the odds of 30-day mortality, respectively. No differences were observed for 90-day mortality or unfavorable functional outcomes.

Despite aggressive treatment, poor outcomes persist after spontaneous ICH. The unfavorable outcomes appeared to be primarily associated with the direct effects of the initial injury rather than early limitations in care. While lifesaving surgery for supratentorial lesions may delay mortality, it did not significantly impact functional outcomes.

Source: n.neurology.org/content/100/19/e1985