Key summary points
Identification of predictors of short-term death after spontaneous intracerebral hemorrhage (SICH) in the elderly.
AbstractSection FindingsThe short-term case fatality (38.7%) after SICH is high in the elderly. Hematoma volume, decreased level of consciousness and functional reserve, but not age per se, increase the risk of short-term death.
AbstractSection MessageAge per se should not justify any decision of withholding best treatment in elderly SICH patients. Offering the best acute treatment can potentially improve the clinical outcome.
Abstract
Aim
The incidence of spontaneous intracerebral hemorrhage (SICH) increases with age. Data on SICH mortality in the very old are sparse. We aimed to describe the predictors of 30-day SICH mortality in the very elderly in southern Portugal.
Methods
A total of 256 community representative SICH patients aged ≥ 75 years (2009–2016) were included. Multiple logistic regression was used to identify predictors of 30-day mortality.
Results
Mean age was 82.1 years; 57.4% males. The 30-day case fatality was 38.7%. The frequency of patients taking anticoagulants (29.3% vs. 11.5%); comatose (46.9% vs. 2.5%); with hematoma volume ≥ 30 mL (64.6% vs. 13.4%); intraventricular dissection (78.8% vs. 27.4%) was higher in deceased patients (p < 0.05). Survivors were more often admitted to stroke unit (SU) (68.2 vs. 31.3%) and had lower mean admission glycaemia values (p < 0.05). The likelihood of death was increased in patients with higher admission hematoma volume (≥ 30 mL) (OR: 8.817, CI 1.753–44.340, p = 0.008) and with prior to SICH history of ≥ 2 hospitalizations OR = 1.022, CI 1.009–1.069, p = 0.031). Having higher Glasgow coma scale score, OR: 0.522, CI 0.394–0.692, p < 0.001, per unit was associated with reduced risk of death. Age was not an independent risk factor of short-term death.
Conclusions
The short-term mortality is high in very elderly SICH. Prior to SICH history of hospitalization, an indirect and gross marker of coexistent functional reserve, not age per se, increases the risk of short-term death. Other predictors of short-term death are potentially manageable reinforcing the message against any defeatist attitude toward elderly patients with SICH.
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AB, JN, AV, RO and PG collected the primary data. AM undertook the statistical analyses. AM, SP and HN had oversight of the project. All authors contributed to revision and intellectual content of the final submission.
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Batista, A., Osório, R., Varela, A. et al. Prediction of short-term prognosis in elderly patients with spontaneous intracerebral hemorrhage. Eur Geriatr Med 12, 1267–1273 (2021). https://doi.org/10.1007/s41999-021-00529-w
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DOI: https://doi.org/10.1007/s41999-021-00529-w