Bernice Limann, Kwadwo Darko, Emmanuel Kwadwo Adjei Osei, Nina Dwumfour-Poku, Michael Farid, Samuel Benjamin Nkansah, Abdallah Tikuma Faisal, Kwasi Kyei Ofei, Joseph Danwura Tanlongo, Mina Guirguis, Pearl Ohenewaa Tenkorang, Umaru Barrie, Adams Fuseini, Teddy Totimeh
{"title":"加纳一家三级医院自发性脑内出血患者院内死亡率的预测因素：回顾性分析。","authors":"Bernice Limann, Kwadwo Darko, Emmanuel Kwadwo Adjei Osei, Nina Dwumfour-Poku, Michael Farid, Samuel Benjamin Nkansah, Abdallah Tikuma Faisal, Kwasi Kyei Ofei, Joseph Danwura Tanlongo, Mina Guirguis, Pearl Ohenewaa Tenkorang, Umaru Barrie, Adams Fuseini, Teddy Totimeh","doi":"10.1227/neuprac.0000000000000120","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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, χ<sup>2</sup>, and logistic and Cox regression to identify predictors of mortality and time to mortality.</p><p><strong>Results: </strong>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%, <i>P</i> = .002). The average Glasgow Coma Scale (GCS) score at presentation was lower in the mortality group (8.19 vs 12.5, <i>P</i> < .001). Patients who died had a higher initial systolic blood pressure (SBP) (179 vs 163 mm Hg, <i>P</i> = .004). Imaging showed a mean hematoma volume of (35.2 mL vs 22.7 mL, <i>P</i> = .112). Intraventricular extension was present in (69.7% vs 50.5%, <i>P</i> = .024). Predictors of in-hospital mortality were intraventricular extension (odds ratio: 2.18, 95% CI: 1.13-4.19, <i>P</i> = .019), management complications (OR: 10.76, 95% CI: 3.99-29.06, <i>P</i> < .001), and increasing mean SBP (OR: 1.02, 95% CI: 1.00-1.03, <i>P</i> = .023). Independent predictors of earlier time to mortality were a drop in GCS (hazard ratio: 3.28, 95% CI: 1.86-5.80, <i>P</i> < .001) and increasing ICH score (hazard ratio: 1.51, 95% CI: 1.24-1.85, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00120"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809969/pdf/","citationCount":"0","resultStr":"{\"title\":\"Predictors of In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage in a Tertiary Hospital in Ghana: A Retrospective Analysis.\",\"authors\":\"Bernice Limann, Kwadwo Darko, Emmanuel Kwadwo Adjei Osei, Nina Dwumfour-Poku, Michael Farid, Samuel Benjamin Nkansah, Abdallah Tikuma Faisal, Kwasi Kyei Ofei, Joseph Danwura Tanlongo, Mina Guirguis, Pearl Ohenewaa Tenkorang, Umaru Barrie, Adams Fuseini, Teddy Totimeh\",\"doi\":\"10.1227/neuprac.0000000000000120\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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, χ<sup>2</sup>, and logistic and Cox regression to identify predictors of mortality and time to mortality.</p><p><strong>Results: </strong>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%, <i>P</i> = .002). The average Glasgow Coma Scale (GCS) score at presentation was lower in the mortality group (8.19 vs 12.5, <i>P</i> < .001). Patients who died had a higher initial systolic blood pressure (SBP) (179 vs 163 mm Hg, <i>P</i> = .004). Imaging showed a mean hematoma volume of (35.2 mL vs 22.7 mL, <i>P</i> = .112). Intraventricular extension was present in (69.7% vs 50.5%, <i>P</i> = .024). Predictors of in-hospital mortality were intraventricular extension (odds ratio: 2.18, 95% CI: 1.13-4.19, <i>P</i> = .019), management complications (OR: 10.76, 95% CI: 3.99-29.06, <i>P</i> < .001), and increasing mean SBP (OR: 1.02, 95% CI: 1.00-1.03, <i>P</i> = .023). Independent predictors of earlier time to mortality were a drop in GCS (hazard ratio: 3.28, 95% CI: 1.86-5.80, <i>P</i> < .001) and increasing ICH score (hazard ratio: 1.51, 95% CI: 1.24-1.85, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":74298,\"journal\":{\"name\":\"Neurosurgery practice\",\"volume\":\"5 4\",\"pages\":\"e00120\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-11-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809969/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgery practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1227/neuprac.0000000000000120\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1227/neuprac.0000000000000120","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的：自发性脑出血（siich）具有高死亡率和发病率负担，其预后受多种因素影响。本研究的目的是确定加纳一家三级医院siich患者住院预后的预测因素。方法：在这项由机构审查委员会批准的回顾性研究中，对2021年至2023年在加纳大学医学中心接受sICH治疗的成年患者进行了回顾性研究，以确定社会人口统计学、临床特征和管理策略与院内预后之间的关系。根据住院结果，将患者分为“死亡”组和“生存”组。采用Wilcoxon秩和、χ2、logistic和Cox回归进行统计分析，以确定死亡率和死亡时间的预测因素。结果：168例患者中，死亡71例（42.3%），两组均以男性为主（分别为60.6%和70.1%）。意识水平改变在死亡病例中更为常见（70.4% vs 45.4%, P = 0.002）。死亡组患者就诊时格拉斯哥昏迷评分（GCS）平均评分较低（8.19比12.5,P < 0.001）。死亡患者的初始收缩压（SBP）较高（179 vs 163 mm Hg, P = 0.004）。影像显示平均血肿体积（35.2 mL vs 22.7 mL, P = .112）。脑室内伸展存在（69.7% vs 50.5%, P = 0.024）。院内死亡率的预测因子为脑室内扩张（优势比：2.18,95% CI: 1.13-4.19, P = 0.019）、治疗并发症（OR: 10.76, 95% CI: 3.99-29.06, P < 0.001）和平均收缩压升高（OR: 1.02, 95% CI: 1.00-1.03, P = 0.023）。较早死亡时间的独立预测因子为GCS下降（风险比：3.28,95% CI: 1.86-5.80, P < 0.001）和ICH评分升高（风险比：1.51,95% CI: 1.24-1.85, P < 0.001）。结论：院内死亡率的预测因素包括脑室扩张、治疗并发症、GCS变化和收缩压升高。识别和减轻这些因素，以及实施快速干预方案，对于改善siich患者的预后至关重要。
Predictors of In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage in a Tertiary Hospital in Ghana: A Retrospective Analysis.
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.
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