Risk Factors for Early Poor Outcomes in In-hospital Intracranial Hemorrhage: A Retrospective Cohort Study.

Abstract

Background: Compared to in-hospital ischemic stroke, the prognosis of in-hospital intracranial hemorrhage (IH-ICH) remains poorly understood. We aimed to analyze the risk factors for early poor outcomes and propose a novel predictive nomogram for in-hospital ICH.

Methods: We retrospectively analyzed data of patients with in-hospital ICH treated in our hospital between 2014 and 2022. Baseline demographics, comorbidities, clinical characteristics, and outcomes were collected. The early poor outcome was defined as in-hospital death or discharge against medical advice. Univariate and multivariate logistic regressions were used to identify the risk factors and then construct a nomogram. The nomogram was compared with the ICH score in terms of predictive ability.

Results: A total of 196 patients were included; the median age was 57.0 (interquartile range 40.0-67.0) years, and 84 (49.7%) patients were male. Among the cohort, 135 patients had intraparenchymal hemorrhage, 27 had subarachnoid hemorrhage, 1 had intraventricular hemorrhage, 5 had subdural hemorrhage, and 1 had epidural hemorrhage. Overall, 96 (56.8%) patients developed an early poor outcome. Multivariate logistic regression identified prior spontaneous extracranial hemorrhage (ECH), baseline modified Rankin Scale (mRS) score ≥ 4, baseline Glasgow Coma Scale (GCS) score ≤ 8, and systemic disease etiology as independent risk factors for early poor outcomes. The IH-ICH nomogram, developed based on these risk factors, had good calibration and superior predictive performance compared to the conventional ICH score (area under the receiver operating characteristic curve 0.894 vs. 0.743, p < 0.001). Besides, the decision curve analysis curves revealed greater positive net benefit of the model than the ICH score.

Conclusions: Patients with prior ECH, severe coma (GCS score ≤ 8), poor functional status (mRS score ≥ 4), and systemic disease etiology face a significant risk of early poor outcomes. The IH-ICH nomogram incorporating these factors offers a promising tool for identifying high-risk patients with in-hospital ICH, thereby contributing to improved patient care and resource allocation in neurology and critical care settings.