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

• Published in: BMJ open Vol. 13; no. 4; p. e066186
• Main Authors: Nguyen, Tuan Anh, Mai, Ton Duy, Vu, Luu Dang, Dao, Co Xuan, Ngo, Hung Manh, Hoang, Hai Bui, Tran, Tuan Anh, Pham, Trang Quynh, Pham, Dung Thi, Nguyen, My Ha, Nguyen, Linh Quoc, Dao, Phuong Viet, Nguyen, Duong Ngoc, Vuong, Hien Thi Thu, Vu, Hung Dinh, Nguyen, Dong Duc, Vu, Thanh Dang, Nguyen, Dung Tien, Do, Anh Le Ngoc, Pham, Quynh Thi, Khuat, Nhung Hong, Duong, Ninh Van, Ngo, Cong Chi, Do, Son Ngoc, Nguyen, Hao The, Nguyen, Chi Van, Nguyen, Anh Dat, Luong, Chinh Quoc
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 21.04.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: accident & emergency medicine; adult intensive & critical care; Aneurysms; Cerebral Hemorrhage - complications; Cohort analysis; Coma; Data collection; Emergency Medicine; Fatalities; Female; Hematoma - diagnostic imaging; Hematoma - epidemiology; Hematoma - etiology; Hemorrhage; Hospitals; Humans; Hydrocephalus; Intracranial Aneurysm - complications; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Male; Medical imaging; Middle Aged; Mortality; neurosurgery; Patients; Prospective Studies; stroke; Stroke - complications; stroke medicine; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnostic imaging; Treatment Outcome; Variables; Vietnam - epidemiology; Vietnam; accident & emergency medicine; neurosurgery; stroke medicine; stroke; adult intensive & critical care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-066186

ObjectivesTo 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.DesignA multicentre prospective cohort study.SettingThree central hospitals in Hanoi, Vietnam.ParticipantsThis 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 measuresThe 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.ResultsOf 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.ConclusionsIn 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.