Determinants of acute and subacute case-fatality in elderly patients with hypertensive intracerebral hemorrhage

Abstract

Background: Given that limited reports have described the survival and risk factors for elderly patients with hypertensive intracerebral hemorrhage (HICH), we aimed to develop a valid but simple prediction nomogram for the survival of HICH patients. Methods: All elderly patients ≥65 years old who were diagnosed with HICH between January 2011 and December 2019 were identified. We performed the least absolute shrinkage and selection operator (Lasso) on the Cox regression model with the R package glmnet. A concordance index was performed to calculate the nomogram discrimination; and calibration curves and decision curves were graphically evaluated by depicting the observed rates against the probabilities predicted by the nomogram. Results: A total of 204 eligible patients were analyzed, and over 20 % of the population was above the age of 80 (65–79 years old, n = 161; 80+ years old, n = 43). A hematoma volume ≥13.64 cm3 was associated with higher 7-day mortality (OR = 6.773, 95 % CI = 2.622–19.481; p < 0.001) and higher 90-day mortality (OR = 3.955, 95 % CI = 1.611–10.090, p = 0.003). A GCS score between 13 and 15 at admission was associated with a 7-day favorable outcome (OR = 0.025, 95 % CI = 0.005–0.086; p < 0.001) and a 90-day favorable outcome (OR = 0.033, 95 % CI = 0.010–0.099; p < 0.001). Conclusions: Our nomogram models were visualized and accurate. Neurosurgeons could use them to assess the prognostic factors and provide advice to patients and their relatives.

Keywords

• Elderly
• Hypertensive intracerebral hemorrhage
• Mortality
• Morbidity
• Nomogram