Cindea Cosmin, Saceleanu Vicentiu, Tudor Victor, Canning Patrick, Petrascu Ovidiu, Kerekes Tamas, Breazu Alexandru, Roman-Filip Iulian, Roman-Filip Corina, Mihaila Romeo
Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania.
County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania.
NeuroSci. 2025 Aug 12;6(3):77. doi: 10.3390/neurosci6030077.
Spontaneous intracerebral hemorrhage (ICH) has the highest case fatality of all stroke types, yet recent epidemiological and outcome data from Central and Eastern Europe remain limited.
We retrospectively analyzed prospectively collected data for 601 consecutive adults with primary ICH admitted to Sibiu County Clinical Emergency Hospital, Romania (2017-2023). Demographics, Glasgow Coma Scale (GCS), CT-derived hematoma volume (ABC/2), anatomical site, intraventricular extension (IVH), treatment, comorbidities, and in-hospital death were reported with exact counts and percentages; no imputation was performed.
Mean age was 68.4 ± 12.9 years, and 59.7% were male. Mean hematoma volume was 30.4 mL, and 23.0% exceeded 30 mL. IVH occurred in 40.1% and doubled mortality (50.6% vs. 16.7%). Overall case fatality was 29.6% and climbed to 74.5% for brain-stem bleeds. Men, although younger than women (66.0 vs. 71.9 years), died more often (35.4% vs. 21.1%; risk ratio 1.67, 95% CI 1.26-2.21). Systemic hazards amplified death risk: Oral anticoagulation, 44.2%; chronic alcohol misuse, 51.4%; thrombocytopenia, 41.0%; chronic kidney disease, 42.3%. Conservative management (74.9%) yielded 27.8% mortality overall and ≤15 for small-to-mid lobar or capsulo-lenticular bleeds; lobar surgery matched this (13.4%) only in large clots. Thalamic evacuation was futile (82.3% mortality), and cerebellar decompression performed late still carried 54.5% mortality versus 16.6% medically. Multivariable analysis confirmed that low GCS, IVH, large hematoma volume, thrombocytopenia, and chronic alcohol use independently predicted in-hospital mortality.
This retrospective study lacked post-discharge functional outcome data (e.g., mRS at 90 days).
This study presents the largest Romanian single-center ICH cohort, establishing national benchmarks and underscoring modifiable risk factors. Early ICH lethality aligns with Western data but is amplified by exposures such as alcohol misuse, anticoagulation, thrombocytopenia, and CKD. Priorities include preventive strategies, timely surgical access, wider adoption of minimally invasive techniques, and development of a prospective regional registry.
自发性脑出血（ICH）在所有中风类型中病死率最高，但中东欧地区近期的流行病学和结局数据仍然有限。
我们回顾性分析了罗马尼亚锡比乌县临床急救医院（2017 - 2023年）连续收治的601例原发性ICH成年患者的前瞻性收集数据。报告了人口统计学数据、格拉斯哥昏迷量表（GCS）、CT衍生的血肿体积（ABC/2）、解剖部位、脑室内扩展（IVH）、治疗方法、合并症和院内死亡情况，以确切计数和百分比表示；未进行插补。
平均年龄为68.4±12.9岁，男性占59.7%。平均血肿体积为30.4 mL，23.0%超过30 mL。IVH发生率为40.1%，死亡率翻倍（50.6%对16.7%）。总体病死率为29.6%，脑干出血的病死率升至74.5%。男性虽然比女性年轻（66.0岁对71.9岁），但死亡频率更高（35.4%对21.1%；风险比1.67，95%置信区间1.26 - 2.21）。全身性危险因素增加了死亡风险：口服抗凝药，44.2%；慢性酒精滥用，51.4%；血小板减少症，41.0%；慢性肾脏病，42.3%。保守治疗（74.9%）总体死亡率为27.8%，中小叶或豆状核出血的死亡率≤15%；叶部手术仅在大血块时与之相当（13.4%）。丘脑血肿清除术无效（死亡率82.3%），晚期进行的小脑减压术死亡率仍为54.5%，而药物治疗为16.6%。多变量分析证实，低GCS、IVH、血肿体积大、血小板减少症和慢性酒精使用独立预测院内死亡率。
这项回顾性研究缺乏出院后功能结局数据（例如，90天时的改良Rankin量表评分）。
本研究展示了罗马尼亚最大的单中心ICH队列，确立了国家基准并强调了可改变的危险因素。ICH早期病死率与西方数据一致，但因酒精滥用、抗凝、血小板减少症和慢性肾脏病等暴露因素而增加。优先事项包括预防策略、及时的手术途径、更广泛采用微创技术以及建立前瞻性区域登记系统。
