Predicting in-hospital mortality in Iranian patients with spontaneous intracerebral hemorrhage.

  • Babak Bakhshayesh Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.
  • Mozaffar Hosseininezhad Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.
  • Seyed Mohammad Seyed Saadat School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
  • Morvarid Hajmanuchehri Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.
  • Ehsan Kazemnezhad Department of Biostatistics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
  • Amir-Reza Ghayeghran Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Keywords: Hematoma, Intracerebral Hemorrhage, Mortality, Outcome


Background: Intracerebral  hemorrhage (ICH) is the  most fatal subtype  of stroke.  Despite  limited effective therapy, there  is no  accepted clinical grading  scale to  predict  in- hospital  mortality,  especially  in developing  nations.  The purpose  of this study was to assess the  predictors  of in- hospital mortality among a sample of Iranian patients  with spontaneous ICH for use at the time of the first evaluation.
Methods: This prospective  study was carried from January 2010 to  the  end  of January  2011. Demographic, clinical, and   laboratory   data   of  ICH   patients   were   collected. Hematoma  volume and perihematoma edema  (PHE) were measured   on  brain  computed  tomography scan  using ABC/2 formula. Logistic regression analysis was performed to determine independent variables contributing to in- hospital mortality.
Results:  Of  a  total   167  consecutive   ICH   patients,  98 patients  met inclusion criteria. Mean ± standard  deviation age  of  patients   was  70.16  ±  12.52.  Afte   multivariate analysis, five variables remained as independent predictors of   in-hospital    mortality    included:   age    [odds    ratio (OR)  =  1.12,  95%  confidence   interval  (CI)   =  1.03-1.23, P = 0.009], diabetes  mellitus (OR = 10.86, 95% CI = 1.08- 109.24, P = 0.009), National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.41, 95% CI = 1.08-1.68, P ≤ 0.001), as well as volume of hematoma (OR = 1.1, 95% CI = 1.03-1.17, P  =  0.003),  and  PHE  (OR  =  0.75,  95%  CI  =  0.60-0.93, P = 0.010).
Conclusion: Our results indicate  that  older age, diabetes mellitus,  higher   NIHSS,  as   well  as  larger   volume   of hematoma, and  smaller PHE on admission  are important predictors of in-hospital mortality in our ICH patients.


1. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 2007; 38(6): 2001-23.
2. Kissela B, Schneider A, Kleindorfer D, Khoury J, Miller R, Alwell K, et al. Stroke in a biracial population: the excess burden of stroke among blacks. Stroke 2004; 35(2): 426-31.
3. Counsell C, Boonyakarnkul S, Dennis M, Sandercock P, Bamford J, Burn J, et al. Primary Intracerebral Haemorrhage in the Oxfordshire Community Stroke Project. Cerebrovascular Diseases 1995; 5(1): 26-34.
4. Zia E, Engstrom G, Svensson PJ, Norrving B, Pessah-Rasmussen H. Three-year survival and stroke recurrence rates in patients with primary intracerebral hemorrhage. Stroke 2009; 40(11): 3567-73.
5. Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population- based registry. Stroke 2009; 40(2): 394-9.
6. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9(2): 167-76.
7. Lukic S, Cojbasic Z, Peric Z, Milosevic Z, Spasic M, Pavlovic V, et al. Artificial neural networks based early clinical prediction of mortality after spontaneous intracerebral hemorrhage. Acta Neurol Belg 2012; 112(4): 375-82.
8. Adeoye O, Broderick JP. Advances in the management of intracerebral hemorrhage. Nat Rev Neurol 2010; 6(11): 593-601.
9. Hwang BY, Appelboom G, Kellner CP, Carpenter AM, Kellner MA, Gigante PR, et al. Clinical grading scales in intracerebral hemorrhage. Neurocrit Care 2010; 13(1): 141-51.
10. Chuang YC, Chen YM, Peng SK, Peng SY. Risk stratification for predicting 30-day mortality of intracerebral hemorrhage. Int J Qual Health Care 2009; 21(6): 441-7.
11. Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke 2008; 39(8): 2304-9.
12. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001; 32(4): 891-7.
13. Cho DY, Chen CC, Lee WY, Lee HC, Ho LH. A new Modified Intracerebral Hemorrhage score for treatment decisions in basal ganglia hemorrhage--a randomized trial. Crit Care Med 2008; 36(7): 2151-6.
14. Ruiz-Sandoval JL, Chiquete E, Romero- Vargas S, Padilla-Martinez JJ, Gonzalez- Cornejo S. Grading scale for prediction of outcome in primary intracerebral hemorrhages. Stroke 2007; 38(5): 1641-4.
15. Togha M, Bakhtavar K. Factors associated with in-hospital mortality following intracerebral hemorrhage: a three-year study in Tehran, Iran. BMC Neurol 2004; 4: 9.
16. Ahmed R, Shakir AH, Moizuddin SS, Haleem A, Ali S, Durrani K, et al. Predictors of in-hospital mortality for intracerebral hemorrhage: a hospital-based study in Pakistani adults. J Stroke Cerebrovasc Dis 2001; 10(3): 122-7.
17. Morgenstern LB, Hemphill JC, Anderson C, Becker K, Broderick JP, Connolly ES, Jr., et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41(9): 2108-29.
18. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke 1996; 27(8): 1304-5.
19. Mansouri B, Heidari K, Asadollahi S, Nazari M, Assarzadegan F, Amini A. Mortality and functional disability after spontaneous intracranial hemorrhage: the predictive impact of overall admission factors. Neurol Sci 2013; 34(11): 1933-9.
20. Arboix A, Massons J, Garcia-Eroles L, Oliveres M, Targa C. Diabetes is an independent risk factor for in-hospital mortality from acute spontaneous intracerebral hemorrhage. Diabetes Care 2000; 23(10): 1527-32.
21. Zafonte RD, Hammond FM, Mann NR, Wood DL, Black KL, Millis SR. Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil 1996; 75(5): 364-9.
22. Gujjar AR, Jacob PC, Nandhagopal R, Ganguly SS, Obaidy A, Al-Asmi AR. Full Outline of UnResponsiveness score and Glasgow Coma Scale in medical patients with altered sensorium: interrater reliability and relation to outcome. J Crit Care 2013; 28(3): 316-8.
23. Cheung RT, Zou LY. Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage. Stroke 2003; 34(7): 1717-22.
24. Weimar C, Roth M, Willig V, Kostopoulos P, Benemann J, Diener HC. Development and validation of a prognostic model to predict recovery following intracerebral hemorrhage. J Neurol 2006; 253(6): 788-93.
25. Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet 2009; 373(9675): 1632-44.
26. Gebel JM, Jr., Jauch EC, Brott TG, Khoury J, Sauerbeck L, Salisbury S, et al. Relative edema volume is a predictor of outcome in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke 2002; 33(11): 2636-41.
27. Arima H, Wang JG, Huang Y, Heeley E, Skulina C, Parsons MW, et al. Significance of perihematomal edema in acute intracerebral hemorrhage: the INTERACT trial. Neurology 2009; 73(23): 1963-8.
28. Staykov D, Wagner I, Volbers B, Hauer EM, Doerfler A, Schwab S, et al. Natural course of perihemorrhagic edema after intracerebral hemorrhage. Stroke 2011; 42(9): 2625-9.
29. Carhuapoma JR, Hanley DF, Banerjee M, Beauchamp NJ. Brain edema after human cerebral hemorrhage: a magnetic resonance imaging volumetric analysis. J Neurosurg Anesthesiol 2003; 15(3): 230-3.
How to Cite
Bakhshayesh B, Hosseininezhad M, Seyed Saadat SM, Hajmanuchehri M, Kazemnezhad E, Ghayeghran A-R. Predicting in-hospital mortality in Iranian patients with spontaneous intracerebral hemorrhage. Iran J Neurol. 13(4):231-236.
Special Articles