Clinical Profiles and Predictors of Mortality in Intracerebral Hemorrhage: A Prospective Cohort Study From Western India.

backgroundIntracerebral hemorrhage (ICH) is a significant type of stroke associated with high early mortality. While certain risk factors are known, detailed clinical profiles and predictors of death, especially in varied healthcare environments, require further investigation to guide treatment strategies.

objectiveThis study aimed to measure how common modifiable and non-modifiable risk factors are in ICH patients and to determine which clinical, biochemical, and radiological factors predict death using standard severity scales.

methodsAn observational study enrolled 100 consecutive ICH patients with altered sensorium at Sir Takhtasinhji General Hospital, Bhavnagar, India, over a 12-month period. Data included demographics, comorbidities (hypertension, diabetes, smoking, alcohol), clinical features (hemiplegia, speech disorders), admission blood pressure, biochemical markers (hemoglobin (Hb), random blood sugar (RBS)), hematoma characteristics (volume/location via imaging), and severity scores (Glasgow Coma Scale (GCS), ICH, National Institutes of Health Stroke Scale (NIHSS)). Outcomes (survival/mortality) were analyzed using regression to identify predictors (SPSS; p<0.05 significant).

resultsThe study found high rates of modifiable risk factors: smoking (N=56; 56%), alcohol use (N=40; 40%), hypertension (N=42; 42%), and diabetes (N=44; 44%). Clinically, hemiplegia was present in 82% (N=82) of patients, speech disorder in 68% (N=68), and altered sensorium in 56% (N=56). Admission blood pressure was elevated on average (systolic blood pressure (SBP) 148 mmHg; diastolic blood pressure (DBP) 88 mmHg). Basal ganglia hemorrhage was the most common hematoma location (N=43; 43%), followed by lobar (N=25; 25%) and thalamic (N=19; 19%) sites. Patients had severe presentations: average GCS was 8.7, ICH score 2.1, and NIHSS 19.1. Several factors significantly predicted higher mortality: altered sensorium, speech disorders, high blood sugar (hyperglycemia), elevated admission blood pressure, a higher ICH score, intraventricular bleeding, and the need for ventilator support. Overall mortality was 33% (N=33).

conclusionsThis study identifies admission hyperglycemia, hypertension, and neurologic impairment (GCS ≤8) as modifiable predictors of ICH mortality, emphasizing urgent targeting of these factors in low- to middle-income country (LMIC) settings. Novel findings include the dominant role of speech disorders and hyperglycemia, previously underprioritized, in prognostication. Future research must validate rapid intervention protocols for these predictors and explore socioeconomic barriers to care.