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Factors related to intracerebral haematoma in patients with aneurysmal subarachnoid haemorrhage in Vietnam: a multicentre prospective cohort study

TA. Nguyen, TD. Mai, LD. Vu, CX. Dao, HM. Ngo, HB. Hoang, TA. Tran, TQ. Pham, DT. Pham, MH. Nguyen, LQ. Nguyen, PV. Dao, DN. Nguyen, HTT. Vuong, HD. Vu, DD. Nguyen, TD. Vu, DT. Nguyen, ALN. Do, QT. Pham, NH. Khuat, NV. Duong, CC. Ngo, SN. Do, HT....

. 2023 ; 13 (4) : e066186. [pub] 20230421

Language English Country England, Great Britain

Document type Multicenter Study, Journal Article

Persistent link   https://www.medvik.cz/link/bmc23011735

OBJECTIVES: To investigate the impact of intracerebral haematoma (ICH) on the outcomes and the factors related to an ICH in patients with aneurysmal subarachnoid haemorrhage (aSAH) in a low- and middle-income country. DESIGN: A multicentre prospective cohort study. SETTING: Three central hospitals in Hanoi, Vietnam. PARTICIPANTS: This study included all patients (≥18 years) presenting with aSAH to the three central hospitals within 4 days of ictus, from August 2019 to June 2021, and excluded patients for whom the admission Glasgow Coma Scale was unable to be scored or patients who became lost at 90 days of follow-up during the study. OUTCOME MEASURES: The primary outcome was ICH after aneurysm rupture, defined as ICH detected on an admission head CT scan. The secondary outcomes were 90-day poor outcomes and 90-day death. RESULTS: Of 415 patients, 217 (52.3%) were females, and the median age was 57.0 years (IQR: 48.0-67.0). ICH was present in 20.5% (85/415) of patients with aSAH. There was a significant difference in the 90-day poor outcomes (43.5% (37/85) and 29.1% (96/330); p=0.011) and 90-day mortality (36.5% (31/85) and 20.0% (66/330); p=0.001) between patients who had ICH and patients who did not have ICH. The multivariable regression analysis showed that systolic blood pressure (SBP) ≥140 mm Hg (adjusted odds ratio (AOR): 2.674; 95% CI: 1.372 to 5.214; p=0.004), World Federation of Neurosurgical Societies (WFNS) grades II (AOR: 3.683; 95% CI: 1.250 to 10.858; p=0.018) to V (AOR: 6.912; 95% CI: 2.553 to 18.709; p<0.001) and a ruptured middle cerebral artery (MCA) aneurysm (AOR: 3.717; 95% CI: 1.848 to 7.477; p<0.001) were independently associated with ICH on admission. CONCLUSIONS: In this study, ICH was present in a substantial proportion of patients with aSAH and contributed significantly to a high rate of poor outcomes and death. Higher SBP, worse WFNS grades and ruptured MCA aneurysms were independently associated with ICH on admission.

Center for Critical Care Medicine Bach Mai Hospital Hanoi Viet Nam

Center for Emergency Medicine Bach Mai Hospital Hanoi Viet Nam

Department of Emergency Agriculture General Hospital Hanoi Viet Nam

Department of Emergency and Critical Care Medicine Hanoi Medical University Hanoi Viet Nam

Department of Emergency Military Central Hospital 108 Hanoi Viet Nam

Department of Emergency Vietnam Czechoslovakia Friendship Hospital Hai Phong Viet Nam

Department of Health Organization and Management Faculty of Public Health Thai Binh University of Medicine and Pharmacy Thai Binh Viet Nam

Department of Intensive Care and Poison Control Dien Bien Provincial General Hospital Dien Bien Phu Viet Nam

Department of Intensive Care and Poison Control Duc Giang General Hospital Hanoi Viet Nam

Department of Neurosurgery 2 Neurosurgery Center Vietnam Germany Friendship Hospital Hanoi Viet Nam

Department of Neurosurgery Bach Mai Hospital Hanoi Viet Nam

Department of Nutrition and Food Safety Faculty of Public Health Thai Binh University of Medicine and Pharmacy Thai Binh Viet Nam

Department of Radiology Hanoi Medical University Hanoi Viet Nam

Department of Surgery Hanoi Medical University Hanoi Viet Nam

Emergency and Critical Care Department Hanoi Medical University Hospital Hanoi Medical University Hanoi Viet Nam

Faculty of Medicine University of Medicine and Pharmacy Vietnam National University Hanoi Viet Nam

Radiology Centre Bach Mai Hospital Hanoi Viet Nam

Stroke Center Bach Mai Hospital Hanoi Viet Nam

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$a OBJECTIVES: To investigate the impact of intracerebral haematoma (ICH) on the outcomes and the factors related to an ICH in patients with aneurysmal subarachnoid haemorrhage (aSAH) in a low- and middle-income country. DESIGN: A multicentre prospective cohort study. SETTING: Three central hospitals in Hanoi, Vietnam. PARTICIPANTS: This study included all patients (≥18 years) presenting with aSAH to the three central hospitals within 4 days of ictus, from August 2019 to June 2021, and excluded patients for whom the admission Glasgow Coma Scale was unable to be scored or patients who became lost at 90 days of follow-up during the study. OUTCOME MEASURES: The primary outcome was ICH after aneurysm rupture, defined as ICH detected on an admission head CT scan. The secondary outcomes were 90-day poor outcomes and 90-day death. RESULTS: Of 415 patients, 217 (52.3%) were females, and the median age was 57.0 years (IQR: 48.0-67.0). ICH was present in 20.5% (85/415) of patients with aSAH. There was a significant difference in the 90-day poor outcomes (43.5% (37/85) and 29.1% (96/330); p=0.011) and 90-day mortality (36.5% (31/85) and 20.0% (66/330); p=0.001) between patients who had ICH and patients who did not have ICH. The multivariable regression analysis showed that systolic blood pressure (SBP) ≥140 mm Hg (adjusted odds ratio (AOR): 2.674; 95% CI: 1.372 to 5.214; p=0.004), World Federation of Neurosurgical Societies (WFNS) grades II (AOR: 3.683; 95% CI: 1.250 to 10.858; p=0.018) to V (AOR: 6.912; 95% CI: 2.553 to 18.709; p<0.001) and a ruptured middle cerebral artery (MCA) aneurysm (AOR: 3.717; 95% CI: 1.848 to 7.477; p<0.001) were independently associated with ICH on admission. CONCLUSIONS: In this study, ICH was present in a substantial proportion of patients with aSAH and contributed significantly to a high rate of poor outcomes and death. Higher SBP, worse WFNS grades and ruptured MCA aneurysms were independently associated with ICH on admission.
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