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Objective To analyze mortality and functional outcome in patients with severe spontaneous intracerebral hemorrhage (ICH), and identify the clinical characteristics, radiological findings and therapeutic procedures predictive of mortality in the Intensive Care Unit (ICU) and during hospitalization, as well as of poor functional results at 6 months. Design A prospective, observational study was carried out. Setting Neurocritical Care Unit of a university hospital. Patients Patients diagnosed with ICH were included over a period of 23 months. Variables of interest Demographic characteristics, cardiovascular risk factors, regular medication, laboratory test parameters, cranial CT findings, therapeutic procedures and outcome data. Intervention None. Results A total of 186 patients with ICH met the inclusion criteria. Surgery to evacuate ICH was performed in 25.8% of the patients. The mortality rate was 46.7%. The modified Rankin score at 6 months was 5 (RI: 4.6). Multivariate Cox regression analysis showed the presence of diabetes, prior anticoagulation, as well as APACHE II severity and the type of bleeding on the cranial CT scan to be predictors of mortality and poor functional outcomes. On the other hand, neurosurgical procedures and intracranial pressure (ICP) monitoring were associated with better outcomes. Conclusion The presence of comorbidities such as diabetes, or previous anticoagulation, as well as the CT findings were associated to poorer outcomes. In contrast, ICP monitoring and early neurosurgery were predictive of longer survival and better functional outcomes.

Resumen Objetivo Evaluar la mortalidad y el resultado funcional final de los pacientes con hemorragia intraparenquimatosa espontanea grave (HIP). Determinar las caracteristicas clinicas, radiologicas y terapeuticas con mayor poder predictivo sobre la mortalidad en la Unidad de Cuidados Intensivos (UCI) y durante el ingreso hospitalario, asi como sobre los malos resultados funcionales a los 6 meses. Diseno Estudio prospectivo, observacional. Ambito UCI de un hospital universitario. Pacientes Durante 23 meses se incluyo a aquellos pacientes con diagnostico de HIP. Variables de interes Datos demograficos, factores de riesgo cardiovascular, medicacion habitual, datos de laboratorio, tomografia craneal (TC), neuromonitorizacion, manejo terapeutico y evaluacion pronostica. Intervencion Ninguna. Resultados Se incluyo a un total de 186 pacientes. En el 25,8% se realizo evacuacion quirurgica de la HIP. La mortalidad fue del 46,7%. La mediana del Rankin modificado a los 6 meses fue de 5 (RI: 4;6). El analisis multivariante de regresion de Cox mostro que la presencia de diabetes, tratamiento previo con anticoagulantes, la gravedad segun APACHE II y el tipo de hemorragia en la TC de craneo se comportaron como variables predictoras de mortalidad y malos resultados funcionales, mientras que la realizacion de procedimientos neuroquirurgicos y la monitorizacion de la presion intracraneal (PIC) asociaron una mayor supervivencia y mejores resultados. Conclusion La presencia de comorbilidades, como la diabetes o el tratamiento previo con anticoagulantes, asi como los hallazgos de la TC se asociaron a peores resultados. Por contra, el marcador de mayor supervivencia y mejor resultado funcional era la monitorizacion de la PIC, asi como la cirugia precoz.

Objective This study sought to identify clinical variables that may contribute to the development of brain death (BD) in patients with severe supratentorial intracerebral hemorrhage (ICH). Methods A prospective observational study was carried out from 2012 to 2014 and included patients with severe supratentorial ICH (Glasgow Coma Score ≤ 8). Exclusion criteria included aneurysmal or traumatic hemorrhage origin and hemorrhagic transformation of previous ischemic stroke. The following data were collected: clinical variables (past medical history, clinical severity at admission), head computed tomography scan findings, laboratory data, neurosurgical procedures, and immediate complications. Univariate tests and logistic regression analyses were performed to assess the predictive ability of these variables and identify patients at high risk of progression to BD. Results A total of 140 patients with severe supratentorial ICH (median age, 60; 68.6% male) were included. Of these 140 cases, 24 progressed to BD. In the multivariate analysis, the following variables were independently associated with BD outcome after supratentorial ICH: a history of arterial hypertension (odds ratio [OR], 11.254; P = .003), anticoagulant therapy (OR, 3.561; P = .050), presence of photomotor impairment at admission (OR, 7.095; P = .001), rebleeding after supratentorial ICH (OR, 5.613; P = .010), and no neurosurgical hematoma evacuation in ICH (OR, 8.314; P = .001). Conclusions Certain clinical variables are predictive of an increased risk for BD development after supratentorial ICH. This information would be useful for transplant coordinators, permitting early identification of at-risk patients and increasing the availability of potential donors.