Sterba Albert, Sedova Petra, Brown Robert D, Stehlik Albert, Bryndziar Tomas, Cimflova Petra, Zvolsky Miroslav, Belaskova Silvie, Kovacova Ingrid, Bednarik Josef, Mikulík Robert
International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic.
Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Acta Neurol Belg. 2024 Dec;124(6):1945-1958. doi: 10.1007/s13760-024-02612-y. Epub 2024 Aug 5.
Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH.
We identified all patients admitted with spontaneous ICH to hospitals with a certified stroke unit in Brno, the second largest city in the Czech Republic (CR), in 2011, the year of the Czech Population and Housing Census. We reviewed their medical records for risk factors, radiographic parameters, and measures of post-stroke neurological deficit [National Institutes of Health Stroke Scale (NIHSS)]. Using the dates of death from the Czech National Mortality Register, we calculated mortality at 30 days, six months, one year, and three years after the ICH. Multivariate analysis with forward stepwise logistic regression was performed to determine independent predictors of mortality (p < 0.05).
In 2011, 1086 patients with stroke were admitted to the four stroke-certified hospitals in Brno, CR. Of these, 134 had spontaneous ICH, with complete data available in 93 of them entering the final analysis. The mortality at 30 days, 6 months, 1 year, and 3 years post-ICH was 34%, 47%, 51%, and 63%, respectively. The mortality was highest in the first few days post-event, with 50% of patients dying in 255 days and average survival being 884 ± 90 days. Both NIHSS and modified ICH (MICH) score showed to be strong and reliable predictors of short- as well as long-term mortality; the risk of death post-ICH increased with older age and size of ICH. Other risk factors contributing to higher, primarily shorter-term mortality included history of cardiac failure, myocardial infarction, or atrial fibrillation.
In our community-based study, we found that severity of neurological deficit at admission (NIHSS), combined with age and size of ICH, well predicted short- as well as long-term mortality after spontaneous ICH. A history of cardiac failure, myocardial infarction, or atrial fibrillation at presentation were also predictors of mortality, underscoring the need for optimal cardiac management in patients with ICH.
脑出血（ICH）是一种死亡率很高的严重疾病。然而，导致脑出血后长期死亡率的因素在很大程度上尚不清楚。这项基于社区的研究旨在评估自发性脑出血后长期死亡率的预测因素。
我们确定了2011年（捷克人口与住房普查年）在捷克共和国第二大城市布尔诺的设有认证卒中单元的医院中因自发性脑出血入院的所有患者。我们查阅了他们的病历，以获取危险因素、影像学参数和卒中后神经功能缺损的测量值[美国国立卫生研究院卒中量表（NIHSS）]。利用捷克国家死亡登记处的死亡日期，我们计算了脑出血后30天、6个月、1年和3年的死亡率。采用向前逐步逻辑回归进行多变量分析，以确定死亡率的独立预测因素（p < 0.05）。
2011年，1086例卒中患者入住捷克布尔诺的四家认证卒中医院。其中，134例为自发性脑出血，93例有完整数据进入最终分析。脑出血后30天、6个月、1年和3年的死亡率分别为34%、47%、51%和63%。死亡率在事件发生后的头几天最高，50%的患者在255天内死亡，平均生存期为884±90天。NIHSS和改良脑出血（MICH）评分均显示是短期和长期死亡率的强大且可靠的预测因素；脑出血后的死亡风险随着年龄增长和脑出血规模增大而增加。导致更高（主要是短期）死亡率的其他危险因素包括心力衰竭、心肌梗死或心房颤动病史。
在我们基于社区的研究中，我们发现入院时神经功能缺损的严重程度（NIHSS），结合年龄和脑出血规模，能很好地预测自发性脑出血后的短期和长期死亡率。就诊时存在心力衰竭、心肌梗死或心房颤动病史也是死亡率的预测因素，这突出了对脑出血患者进行最佳心脏管理的必要性。
