Predictors of 30-day Mortality and 90-day Functional Recovery after Primary Pontine Hemorrhage

Abstract

The factors related to death and functional recovery after primary pontine hemorrhage (PPH) in Koreans has not been well defined. The authors sought to identify independent predictors of death and functional recovery after PPH using data obtained at a single institute. Data were collected retrospectively on 281 patients with PPH admitted to the Stroke Unit at our hospital between January 1, 2000 and December 31, 2009. Multivariate logistic regression analysis was used to evaluate the associations between selected variables and 30-day mortality and 90-day functional recovery after PPH. One-hundred and ten patients (39.1%) died within 30 days of PPH and 27 patients (9.6%) achieved functional recovery within 90 days. By multivariate analysis, unconsciousness, dilated pupils, abnormal respiration, systolic blood pressure < 100 mmHg, hydrocephalus, and conservative treatment were found to be predictors of 30-day mortality, whereas consciousness, intact motor function, no history of hypertension or diabetes mellitus, intact eye movement, a hematoma volume of < 5 mL, no ventricular hemorrhage, and normally sized ventricle were found to be predictors of 90-day functional recovery. The present findings suggest that systolic hypotension of less than 100 mmHg may predict 30-day mortality and a history of underlying hypertension and diabetes mellitus may predict 90-day functional recovery.

Development and Validation of a Grading Scale for Primary Pontine Hemorrhage

“…7,25,26 Consistently, we found no correlation between mortality and age. [4][5][6]9 The implications of our findings are tempered by several limitations. First, to create a useful tool in early prediction at the bedside, we selected parameters that could be acquired within 24 hours after admission.…”

“…Thus, we stratified both the GCS and PPH volume into 3 scales according to prior studies and our own findings. [4][5][6]14 From our observation, patients with PPH volume <5 mL had a big chance to survive, whereas those with PPH volume >10 mL tended to die at early stage. For PPH volumes between 5 and 10 mL, patients with GCS score of 3 to 4 were highly fatal, whereas those with GCS score of 8 to 15 were more likely to experience functional recovery than those with a score of 5 to 7.…”

“…[4][5][6][7] Medical records were carefully reviewed by using a structured data collection form to obtain the following parameters: age, sex, hypertension, diabetes mellitus, smoking, alcohol abuse, surgery (craniotomy or CT-guided stereotactic hematoma aspiration), extraventricular drainage, and need for mechanical ventilation. Physiological parameters including temperature, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate (ventilated or not), serum white blood cell count, hemoglobin, platelet count, hematocrit, prothrombin time, activated partial thromboplastin time, urea, creatinine, and serum glucose level were the initial records at admission.…”

“…However, inconsistent predictors were reported when different parameters and populations were brought into analysis. [4][5][6][7] As a corollary, it would make cogent sense by combining significant factors into a grading scale to enhance predictive power and, meanwhile, provide a useful tool for physicians in decision-making when facing such patients. 8 Currently, there is no standard, widely accepted early prognostic model or clinical grading scale for outcome prediction in PPH patients.…”

Recovery of an injured corticoreticulospinal tract in a patient with pontine hemorrhage

“…2,3 Therefore, patients with PH are known to become highly disabled, and gait dysfunction is one of the most disabling sequelae of PH: residual gait dysfunction has been reported in more than 20% of patients. 4,5 However, the exact causes of gait dysfunction or recovery mechanism of gait function in patients with PH have not been elucidated.…”