Predictors of good functional outcome after hemorrhagic stroke
Jessica Houck1, Amanda Webb1, Latha Ganti2
1University of Central Florida, 2Envision Physician Services
Objective:

To determine which factors are associated with good functional outcome at 90 days after emergency department presentation for hemorrhagic stroke.

Background:

Hemorrhagic stroke is a devastating condition with uniformly poor prognosis. Recognizing early prognostic markers may be helpful in guiding the management.

Design/Methods:
This was a prospective observational study of consecutive patients with an ultimate diagnosis of acute nontraumatic intracerebral hemorrhage presenting to the emergency department (ED) at a comprehensive stroke center. The dependent variable was functional outcome as measured by the modified Rankin Score (mRS). Dependent variables included stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS), a patient’s basal metabolic index (BMI), blood pressure, past medical history, current use of anticoagulants or antiplatelets, age, and gender.  Statistical
Results:
Of the total cohort (n= 179) 82 had an mRS score recorded 90 days after hospital discharge. The median mRS was 5, with an IQR 4-6. Only 15% had a good functional outcome (mRS<3). The strongest predictor of good functional outcome was lower stroke severity (P<0.0001), followed by higher BMI (P=0.0306) and lower mean arterial pressure (P=0.0471). Other variables in the multivariate model included antiplatelet or anticoagulant use, history or new diagnosis of diabetes mellitus, age and gender, and all of these were non-significant. Overall, this multivariate logistic regression model was robust, with an Rstatistic of 38%.
 
Conclusions:

The prognosis after acute nontraumatic intracerebral hemorrhage is overall poor, with only a small fraction being able to live independently 90 days post discharge. In addition to initial lower stroke severity, a lower blood pressure and higher BMI appear to be protective.