RESUMEN
Intracerebral haemorrhage constitutes 10-20 % of all strokes & remains without treatment of proven benefit & has higher risk of morbidity & mortality than cerebral infarction or subarachnoid bleed. Thus, these models may accurately predict outcome, and hence the purpose of this study is to define a clinical grading scale for patients with ICH which uses criteria that are predictive of outcome & that can be rapidly & accurately assessed at the time of presentation in emergency/casualty. Estimation of basal plasma D-dimer levels an indicator of systemic activation of coagulative & fibrinolytic system has shown to a powerful predictor of both early neurological worsening & mortality outcome & hence the present study is undertaken.METHODSThe study was carried out in the IPD of Department of General Medicine, Basaveshwara Teaching and General Hospital, Kalaburagi, attached to Mahadevappa Rampure Medical College. It is a cross sectional study conducted among 100 intracerebral bleed patients between November 2018 to November 2019 with simple random sampling procedure. Patients were followed up at the end of 1 month with telephone/letter/email.RESULTSThe mortality among patients who scored 0 of ICH scale was 0%, ICH score of 1 was 13.6 %, ICH score of 5 was 100 %. No patient scored 6. Higher the ICH score, higher is the mortality. Mortality among patients with D-Dimer value between 1500 – 5000 ng/ml is 55.2 %, and > 5000 ng/ml is 92.3 %. Above table indicates that higher the basal level of D-Dimer value higher is the mortality. Mortality among patients of either sex was equal i.e., 50 % between 8 - 15 days, and no deaths were noted between 15 - 30 days.CONCLUSIONSIntracerebral haemorrhage (ICH) has remained a serious disease despite recent improvements in management. So, efforts must be directed towards better understanding and modification of risk factors. The major risk factor in our study was hypertension. The other common risk factors were alcohol consumption and smoking. Thus, measures to ensure adequate control of hypertension/compliance of treatment among hypertensive, abstinence from alcohol and smoking may reduce the incidence of ICH. High initial plasma D-Dimer levels would indicate bad prognosis in ICH. In addition to diagnosis of ICH, CT Scan can also be used as a useful tool in assessing prognostic outcome of ICH, by using radiological parameters like larger volume of haematoma, presence of midline shift, intraventricular extension of haemorrhage and hydrocephalus which indicated bad prognosis i.e., using ICH score, higher the ICH score higher is the mortality.
RESUMEN
Background: A simple clinical scale of intracerebral hemorrhage, comprising the Glasgow Coma Scale score, age, Infratentorial origin, ICH volume, and Intraventricular hemorrhage, was recently shown to predict 30-day mortality. We studied how well the original ICH Score would predict morbidity and mortality. Materials and methods: We did a retrospective study, in which records of all the patients with acute intracerebral hemorrhage were reviewed. Components of the ICH Score were recorded along with other clinical characteristics. Outcome was analyzed using modified ranking scale. Results: The mean age was 69 15 years with 45.4% males and 54.6% females. Common risk factors were smoking, diabetes mellitus and hypertension. Supratentorial lesions were 93.25% and Infratentorial lesions were 6.74 %. The overall 30 day mortality rate for ICH was 29.03%. Important predictors of mortality were, GCS score on admission (P<0.0001), hematoma volume >30ml (P <0.0001), Intraventricular extension (P <0.0001), and ICH score (P <0.0001). Conclusion: The study shows ICH score is very useful in prognostication. The overall mortality rate with ICH is similar to the previously published studies.