Predictors of In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage in a Tertiary Hospital in Ghana: A Retrospective Analysis.

Abstract

Background and objectives: Spontaneous intracerebral hemorrhage (sICH) carries a high mortality and morbidity burden, with multiple factors influencing outcomes. The aim of this study was to identify the predictors of in-hospital outcomes for patients with sICH at a tertiary hospital in Ghana.

Methods: In this retrospective study, approved by the Institutional Review Board, adult patients with sICH at the University of Ghana Medical Centre between 2021 and 2023 were reviewed to characterize the association between sociodemographics, clinical features, and management strategies to in-hospital outcomes. Based on in-hospital outcomes, patients were categorized into "mortality" and "survival" groups. Statistical analyses were performed using Wilcoxon rank sum, χ², and logistic and Cox regression to identify predictors of mortality and time to mortality.

Results: Among the 168 patients, 71 (42.3%) died, with a male predominance in both groups (60.6% and 70.1%, respectively). Altered level of consciousness was more common in mortality cases (70.4% vs 45.4%, P = .002). The average Glasgow Coma Scale (GCS) score at presentation was lower in the mortality group (8.19 vs 12.5, P < .001). Patients who died had a higher initial systolic blood pressure (SBP) (179 vs 163 mm Hg, P = .004). Imaging showed a mean hematoma volume of (35.2 mL vs 22.7 mL, P = .112). Intraventricular extension was present in (69.7% vs 50.5%, P = .024). Predictors of in-hospital mortality were intraventricular extension (odds ratio: 2.18, 95% CI: 1.13-4.19, P = .019), management complications (OR: 10.76, 95% CI: 3.99-29.06, P < .001), and increasing mean SBP (OR: 1.02, 95% CI: 1.00-1.03, P = .023). Independent predictors of earlier time to mortality were a drop in GCS (hazard ratio: 3.28, 95% CI: 1.86-5.80, P < .001) and increasing ICH score (hazard ratio: 1.51, 95% CI: 1.24-1.85, P < .001).

Conclusion: Predictors of in-hospital mortality included intraventricular extension, management complications, changes in GCS, and increasing SBP. Identifying and mitigating these factors, along with implementing rapid intervention protocols, are essential for improving outcomes in patients with sICH.