The association between the Charlson Comorbidity Index and prognosis in patients with supratentorial spontaneous intracerebral hemorrhage following hematoma evacuation.

Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) carries high mortality and morbidity. Compared to deep ICH, acute lobar ICH has distinct profiles and poorer early prognosis, frequently associated with non-hypertensive etiologies. The Charlson Comorbidity Index (CCI) is linked to critical ICH outcomes. This study assessed the relationship between CCI and prognosis following hematoma evacuation in supratentorial spontaneous ICH patients.

Methods: Three hundred and eighty-one patients with spontaneous supratentorial ICH underwent hematoma evacuation, with their CCI scores categorized into low and high comorbidity groups. Following an analysis of demographic data, medical history, clinical and imaging characteristics, and poor outcomes [modified Rankin Scale (mRS) 4-6], the study examined the differences in CCI between the two groups. Logistic regression analysis was conducted to assess the correlation between CCI and the poor outcomes in patients with supratentorial ICH after hematoma evacuation.

Results: Of the 381 patients with ICH who underwent hematoma evacuation, the high comorbidity group had a higher proportion of medical histories including diabetes, stroke, hemorrhage, heart disease, and anticoagulant use compared to the low comorbidity group. Additionally, the high comorbidity group exhibited significantly higher preoperative hematoma volume and postoperative hematoma volume than the low comorbidity group. The incidence of postoperative rehemorrhage [23 (6.8%) vs. 7 (17.1%), P=0.045] and 6-month poor outcomes (mRS 4-6) [209 (61.5%) vs. 37 (90.2%), P<0.001] was also higher in the High comorbidity group. According to logistic regression analysis, a high CCI score was independently associated with poor outcomes in Model 1 [Model 1, odds ratio (OR) 5.80; 95% confidence interval (CI): 2.02-16.64; P=0.001]. After adjusting for clinical preset variables in Model 2, the difference remained statistically significant (Model 2, OR 7.48; 95% CI: 2.15-25.96; P=0.002). After adjusting for baseline differences and clinical preset variables, the results remained consistent (Model 3, OR 10.68; 95% CI: 2.76-41.30; P<0.001; Model 4, OR 10.89; 95% CI: 2.75-43.05; P<0.001).

Conclusions: In patients with supratentorial ICH post-evacuation, a higher CCI score correlates with poorer prognosis. The high CCI group has a ninefold increased risk of unfavorable outcomes, which guides clinical treatment and prognostic assessment.