How patients die after intracerebral hemorrhage

Andrew M. Naidech, Richard A. Bernstein, Sarice L. Bassin, Rajeev K. Garg, Storm Liebling, Bernard Bendok, H. Hunt Batjer, Thomas P. Bleck

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Introduction: Severity of illness scores predict all-cause mortality after intracerebral hemorrhage (ICH), but do not differentiate between proximate mechanisms or predict the timing. We hypothesized that death by neurologic criteria [brain death (BD)], withdrawal of life support, and cardiovascular death would be distinct after ICH. Methods: We prospectively enrolled patients with spontaneous ICH without underlying vascular malformation or neoplasm. We recorded clinical data and the proximate mechanism of death (BD, withdrawal of life support, cardiovascular death, or other cause). Time to death was compared with Kaplan-Meier methods (log-rank test). Data are median (IQR). Results: Among 89 patients, 15 had withdrawal of life support, 5 had BD, 2 died from cardiac arrest, and 3 died from other causes. Among patients who died, ICH score, age, Glasgow Coma Scale, NIH Stroke Scale, and proximate cause were not associated with the proximate mechanism of death. The time to death was different (P < 0.001) depending on the proximate mechanism. Patients with BD died 1 [0-1] 1 day after ICH, withdrawal of life support led to death 5 [1-13] days after ICH, cardiac death occurred 35 [35-85] days after ICH, and other causes led to death 33 [26-33] days after ICH. Among patients where life support was withdrawn, a higher ICH score on admission was related to earlier death (P = 0.002). Conclusions: Proximate mechanisms of death after ICH occur at distinct times. Withdrawal of life support leads to earlier death in patients with a higher severity of injury. Medical causes of death can be effectively prevented after ICH.

Original languageEnglish (US)
Pages (from-to)45-49
Number of pages5
JournalNeurocritical Care
Volume11
Issue number1
DOIs
StatePublished - Aug 2009
Externally publishedYes

Fingerprint

Cerebral Hemorrhage
Brain Death
Vascular Neoplasms
Glasgow Coma Scale
Vascular Malformations
Heart Arrest
Nervous System
Cause of Death
Stroke

Keywords

  • Intracerebral hemorrhage
  • Mortality
  • Resuscitation

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Naidech, A. M., Bernstein, R. A., Bassin, S. L., Garg, R. K., Liebling, S., Bendok, B., ... Bleck, T. P. (2009). How patients die after intracerebral hemorrhage. Neurocritical Care, 11(1), 45-49. https://doi.org/10.1007/s12028-009-9186-z

How patients die after intracerebral hemorrhage. / Naidech, Andrew M.; Bernstein, Richard A.; Bassin, Sarice L.; Garg, Rajeev K.; Liebling, Storm; Bendok, Bernard; Batjer, H. Hunt; Bleck, Thomas P.

In: Neurocritical Care, Vol. 11, No. 1, 08.2009, p. 45-49.

Research output: Contribution to journalArticle

Naidech, AM, Bernstein, RA, Bassin, SL, Garg, RK, Liebling, S, Bendok, B, Batjer, HH & Bleck, TP 2009, 'How patients die after intracerebral hemorrhage', Neurocritical Care, vol. 11, no. 1, pp. 45-49. https://doi.org/10.1007/s12028-009-9186-z
Naidech AM, Bernstein RA, Bassin SL, Garg RK, Liebling S, Bendok B et al. How patients die after intracerebral hemorrhage. Neurocritical Care. 2009 Aug;11(1):45-49. https://doi.org/10.1007/s12028-009-9186-z
Naidech, Andrew M. ; Bernstein, Richard A. ; Bassin, Sarice L. ; Garg, Rajeev K. ; Liebling, Storm ; Bendok, Bernard ; Batjer, H. Hunt ; Bleck, Thomas P. / How patients die after intracerebral hemorrhage. In: Neurocritical Care. 2009 ; Vol. 11, No. 1. pp. 45-49.
@article{691322b947ea47c6b13cc8a147a692a4,
title = "How patients die after intracerebral hemorrhage",
abstract = "Introduction: Severity of illness scores predict all-cause mortality after intracerebral hemorrhage (ICH), but do not differentiate between proximate mechanisms or predict the timing. We hypothesized that death by neurologic criteria [brain death (BD)], withdrawal of life support, and cardiovascular death would be distinct after ICH. Methods: We prospectively enrolled patients with spontaneous ICH without underlying vascular malformation or neoplasm. We recorded clinical data and the proximate mechanism of death (BD, withdrawal of life support, cardiovascular death, or other cause). Time to death was compared with Kaplan-Meier methods (log-rank test). Data are median (IQR). Results: Among 89 patients, 15 had withdrawal of life support, 5 had BD, 2 died from cardiac arrest, and 3 died from other causes. Among patients who died, ICH score, age, Glasgow Coma Scale, NIH Stroke Scale, and proximate cause were not associated with the proximate mechanism of death. The time to death was different (P < 0.001) depending on the proximate mechanism. Patients with BD died 1 [0-1] 1 day after ICH, withdrawal of life support led to death 5 [1-13] days after ICH, cardiac death occurred 35 [35-85] days after ICH, and other causes led to death 33 [26-33] days after ICH. Among patients where life support was withdrawn, a higher ICH score on admission was related to earlier death (P = 0.002). Conclusions: Proximate mechanisms of death after ICH occur at distinct times. Withdrawal of life support leads to earlier death in patients with a higher severity of injury. Medical causes of death can be effectively prevented after ICH.",
keywords = "Intracerebral hemorrhage, Mortality, Resuscitation",
author = "Naidech, {Andrew M.} and Bernstein, {Richard A.} and Bassin, {Sarice L.} and Garg, {Rajeev K.} and Storm Liebling and Bernard Bendok and Batjer, {H. Hunt} and Bleck, {Thomas P.}",
year = "2009",
month = "8",
doi = "10.1007/s12028-009-9186-z",
language = "English (US)",
volume = "11",
pages = "45--49",
journal = "Neurocritical Care",
issn = "1541-6933",
publisher = "Humana Press",
number = "1",

}

TY - JOUR

T1 - How patients die after intracerebral hemorrhage

AU - Naidech, Andrew M.

AU - Bernstein, Richard A.

AU - Bassin, Sarice L.

AU - Garg, Rajeev K.

AU - Liebling, Storm

AU - Bendok, Bernard

AU - Batjer, H. Hunt

AU - Bleck, Thomas P.

PY - 2009/8

Y1 - 2009/8

N2 - Introduction: Severity of illness scores predict all-cause mortality after intracerebral hemorrhage (ICH), but do not differentiate between proximate mechanisms or predict the timing. We hypothesized that death by neurologic criteria [brain death (BD)], withdrawal of life support, and cardiovascular death would be distinct after ICH. Methods: We prospectively enrolled patients with spontaneous ICH without underlying vascular malformation or neoplasm. We recorded clinical data and the proximate mechanism of death (BD, withdrawal of life support, cardiovascular death, or other cause). Time to death was compared with Kaplan-Meier methods (log-rank test). Data are median (IQR). Results: Among 89 patients, 15 had withdrawal of life support, 5 had BD, 2 died from cardiac arrest, and 3 died from other causes. Among patients who died, ICH score, age, Glasgow Coma Scale, NIH Stroke Scale, and proximate cause were not associated with the proximate mechanism of death. The time to death was different (P < 0.001) depending on the proximate mechanism. Patients with BD died 1 [0-1] 1 day after ICH, withdrawal of life support led to death 5 [1-13] days after ICH, cardiac death occurred 35 [35-85] days after ICH, and other causes led to death 33 [26-33] days after ICH. Among patients where life support was withdrawn, a higher ICH score on admission was related to earlier death (P = 0.002). Conclusions: Proximate mechanisms of death after ICH occur at distinct times. Withdrawal of life support leads to earlier death in patients with a higher severity of injury. Medical causes of death can be effectively prevented after ICH.

AB - Introduction: Severity of illness scores predict all-cause mortality after intracerebral hemorrhage (ICH), but do not differentiate between proximate mechanisms or predict the timing. We hypothesized that death by neurologic criteria [brain death (BD)], withdrawal of life support, and cardiovascular death would be distinct after ICH. Methods: We prospectively enrolled patients with spontaneous ICH without underlying vascular malformation or neoplasm. We recorded clinical data and the proximate mechanism of death (BD, withdrawal of life support, cardiovascular death, or other cause). Time to death was compared with Kaplan-Meier methods (log-rank test). Data are median (IQR). Results: Among 89 patients, 15 had withdrawal of life support, 5 had BD, 2 died from cardiac arrest, and 3 died from other causes. Among patients who died, ICH score, age, Glasgow Coma Scale, NIH Stroke Scale, and proximate cause were not associated with the proximate mechanism of death. The time to death was different (P < 0.001) depending on the proximate mechanism. Patients with BD died 1 [0-1] 1 day after ICH, withdrawal of life support led to death 5 [1-13] days after ICH, cardiac death occurred 35 [35-85] days after ICH, and other causes led to death 33 [26-33] days after ICH. Among patients where life support was withdrawn, a higher ICH score on admission was related to earlier death (P = 0.002). Conclusions: Proximate mechanisms of death after ICH occur at distinct times. Withdrawal of life support leads to earlier death in patients with a higher severity of injury. Medical causes of death can be effectively prevented after ICH.

KW - Intracerebral hemorrhage

KW - Mortality

KW - Resuscitation

UR - http://www.scopus.com/inward/record.url?scp=70349314341&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70349314341&partnerID=8YFLogxK

U2 - 10.1007/s12028-009-9186-z

DO - 10.1007/s12028-009-9186-z

M3 - Article

VL - 11

SP - 45

EP - 49

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

IS - 1

ER -