Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain.

OBJECTIVE: Validation of the intracerebral haemorrhage (ICH) score in patients with a diagnosis of spontaneous ICH admitted to the intensive care unit (ICU). METHODS: A multicentre cohort study was conducted in all consecutive patients with ICH admitted to the ICUs of three hospitals with a neurosurgery department between 2009 and 2012 in Andalusia, Spain. Data collected included ICH, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Demographic data, location and volume of haematoma and 30-day mortality rate were also collated. RESULTS: A total of 336 patients were included. 105 of whom underwent surgery. Median (IQR) age: 62 (50-70) years. APACHE-II: 21(15-26) points, GCS: 7 (4-11) points, ICH score: 2 (2-3) points. 11.1% presented with bilateral mydriasis on admission (mortality rate=100%). Intraventricular haemorrhage was observed in 58.9% of patients. In-hospital mortality was 54.17% while the APACHE-II predicted mortality was 57.22% with a standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to 1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no significant statistical difference, n.s.). 30-day mortality was 52.38% compared with the ICH score predicted mortality of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality was higher than predicted at the lowest scores and lower than predicted in the more severe patients, (H=55.89, p<0.001), Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva calibration belt (p<0.001). The area under a receiver operating characteristic (ROC) curve was 0.74 (95% CI 0.69 to 0.79). CONCLUSIONS: ICH score shows an acceptable discrimination as a tool to predict mortality rates in patients with spontaneous ICH admitted to the ICU, but its calibration is suboptimal.

Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension.

OBJECTIVE: To conduct a survival study and evaluation of surgical treatment in a cohort of patients with diagnosis of supratentorial spontaneous intracerebral hemorrhage (ICH). MATERIALS AND METHODS: The study included all consecutive patients with supratentorial ICH admitted to the Intensive Care Units of three Spanish hospitals with Neurosurgery Department between 2009 and 2012. DATA COLLECTED: age, APACHE-II, Glasgow Coma Score (GCS), and pupillary anomalies on admission, intracerebral hemorrhage (ICH) score, location/volume of hematoma, intraventricular hemorrhage (IVH), surgical evacuation alone or with additional external ventricular drain, and 30-days survival and at hospital discharge RESULTS: A total of 263 patients were included. Mean age: 59.74±14.14 years. GCS: 8±4 points, APACHE II: 20.7±7.68 points. ICH Score: 2.32+1.04 points. Pupillary anomalies were observed in 30%. The 30-day mortality: 51.3% (45.3% predicted by ICH-score), and 53.2% at hospital discharge. A significant difference (p=0.004) was observed in hospital mortality rates between surgically treated patients (39.7%, n=78) versus those conservatively managed (58.9%, n=185); specifically in those with IVH surgically treated (34.2%, n=38) versus non-operated IVH (67.2%, n=125), p<0.001. No significant difference was found between mortality rates in patients without IVH. Multiple logistic regression analysis showed an OR for surgery of 1.04 (95% CI; 0.33-3.22) in patients without IVH versus 0.19 (95% CI; 0.07-0.53) in patients with IVH (decreased mortality with surgical treatment). The propensity score analysis for IVH patients showed improved survival of operated group (OR 0.23, 95% CI; 0.07-0.75), p=0.01. CONCLUSIONS: Hospital mortality was lower in patients who underwent surgery compared to patients conservatively managed, specifically for the subgroup of patients with intraventricular hemorrhage.

Risk factors for renal dysfunction in the postoperative course of liver transplant.

Renal dysfunction (RD) is a frequent complication after orthotopic liver transplantation (OLT), and it has an unfavorable effect on the prognosis of OLT patients. The purpose of our study was to identify possible risk factors for RD and its impact on survival. The possible relations of pre-, peri-, and postoperative variables to early-onset renal dysfunction (ED) (within the 1st 3 months), late-onset renal dysfunction (LD) (between 3 and 6 months), and chronic renal dysfunction (CRD) (beyond 6 months) was analyzed. We studied 245 liver transplants in 241 patients. RD was found in 64.1% of these patients, and 69% of the patients with RD recovered. LD was found in 16.7% of the transplant patients. In the multivariate analysis, baseline serum creatinine, perioperative volume of transfused bank-red blood cells, Acute Physiology and Chronic Health Evaluation (APACHE) II score at intensive care unit (ICU) admission, and infection were associated with the development of RD. Overall mortality was 27.8% and for the RD group, it was 33.5%. LD, but not ED, was related to lower survival (together with graft dysfunction and APACHE II score at ICU admission). In conclusion, ED is frequent alter OLT and is related to preexisting RD, the volume of transfused bank--red blood cells during surgery, higher APACHE II score at ICU admission, and infection. In general, the prognosis for ED is good, in contrast with that of LD, which is associated with diminished survival.