Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans

Background and Purpose: Intracerebral hemorrhage (ICH) constitutes now 52% of all strokes. Despite of its deadly pattern, locally there is no clinical grading scale for ICH-related mortality prediction. The first objective of this study was to develop a risk stratification scale ( Kinshasa ICH score) by assessing the strength of independent predictors and their association with in-hospital 30-day mortality. The second objective of the study was to create a specific local and African model for ICH prognosis. Materials and Methods: Age, sex, hypertension, type 2 diabetes mellitus (T2DM), smoking, alcohol intake, and neuroimaging data from CT scan ( ICH volume, Midline shift) of patients admitted with primary ICH and follow-upped in 33 hospitals of Kinshasa, DR Congo, from 2005 to 2008, were analyzed using logistic regression models. Results: A total of 185 adults and known hypertensive patients (140 men and 45 women) were examined. 30-day mortality rate was 35% (n= 65). ICH volume> 25 mL (OR= 8 95% CI: 3.1-20.2; P<0.0001), presence of coma (OR=6.8 95% CI 2.6-17.4; P< 0.0001) and left hemispheric site of ICH (OR2.6 95% CI: 1.1- 6; P=0.027) were identified as significant and independent predictors of 30-day mortality. Midline shift > 7 mm, a consequence of ICH volume, was also a significant predictor of mortality. The Kinshasa ICH score was the sum of individual points assigned as follows: Presence of coma coded 2 (2x 2 = 4), absence of coma coded 1 (1x 2 = 2), ICH volume> 25 mL coded 2 (2x2= 4), ICH volume of = 25 mL coded 1(1x2= 2), left hemispheric site of ICH coded 2 (2x1= 2), and right hemispheric site of hemorrhage coded 1(1x 1 = 1). All patients with Kinshasa ICH score = 7 survived and the patients with a score > 7 died. In considering sex influence (Model 3), points were allowed as follows: Presence of coma (2x 3 = 6), absence of coma (1x 3 = 3), men (2x 2 = 4), women (1x 2 = 2), midline shift = 7 mm (1x 3 = 3), and midline shift > 7 mm (2x 3 = 6). Patients who died had the Kinshasa ICH score =16. Conclusion: In this study, the Kinshasa ICH score seems to be an accurate method for distinguishing those ICH patients who need continuous and special management. It needs to be validated among large African hypertensive populations with a high rate of 30-day in-hospital mortality.