Risk factors for mortality in patients with non-traumatic pontine hemorrhage

Abstract

Promptly identifying PH patients who are most likely die is important. The decision to stop life support in patients with PH is difficult, but factors, which are shown in this study, may be used to determine the level of care.

Prognostic factors in pontine haemorrhage: A systematic review

“…History of hypertension, core temperature !39 C, systolic blood pressure <100 mmHg, absent motor response, absent corneal or oculocephalic reflexes, abnormal respiration, and need for mechanical ventilation have all been reported in various studies to independently correlate with death or poor outcome. 10,15,20,22,23 Sex was not a prognostic factor in any of the studies.…”

“…41 Extrapontine extension into the midbrain with or without thalamic involvement was shown by only one study of 118 consecutive PH patients to be independently associated with death within a median follow-up period of 51 days (hazard ratio, 2.2; 95% CI: 1.1-4.4; p ¼ 0.033). 22 Three other studies that examined the effect of parenchymal extension on survival could not confirm this finding. 19,23,26 Haemorrhage expansion is an independent determinant of mortality and functional outcome after ICH.…”

“…Based on 20 studies consisting of 1437 patients, the overall rate of early (within 30 days of PH or shortly thereafter) death of all causes was 48.1% (Table 1). 1,2,4,9,10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] This figure reflects results of studies spanning four decades. The individual mortality rates reported by these studies ranged from 33.7% to 77.5%.…”

“…1,2,10,12,13,[15][16][17][18][19][20][22][23][24] Eight studies, wherein multivariate regression analysis was conducted using either admission coma or GCS score as variables (a total of 968 patients) identified these factors as independent predictors of early mortality (Table 2). 10,17,19,[22][23][24][25][26] Combing the data from studies of PH patients that stratified outcomes strictly based on "coma on admission" and not according to absolute GCS thresholds yielded 585 patients. 1,2,10,12,13,15,17,18 The PPV and NPV, and PLR of coma on admission for early death were 77.2% and 82.9%, and 3.98 (95% confidence interval (CI): 3.18-5.00), respectively.…”

“…Among 12 studies with a total of 1063 patients, 30.3% developed hydrocephalus. 1,2,10,[15][16][17][18][19][20][21][22]25,26 Only one of the three studies that included hydrocephalus as a variable in multivariate analysis found it to be an independent predictor of mortality and functional outcome. 10,19,26 This study was by Jang et al, which estimated the odds ratios for 30-day mortality and 90-day functional recovery (absence of hydrocephalus) at 2.98 (95% CI: 1.84-5.02; p ¼ 0.038) and 2.84 (95% CI: 1.79-5.32; p ¼ 0.03), respectively.…”