Prognostic factors of spontaneous intracerebral haemorrhage in haemodialysis patients and predictors of 30-day mortality

Background: The prognostic factors of intracerebral haemorrhage (ICH) in haemodialysis (HD) patients are not fully clear and there is no standard clinical grading scale to predict 30-day mortality. Our aim was to develop such a scale. Methods: Records of all HD patients with spontaneous ICH presenting to Chang Gung Memorial Hospital in Taiwan during 1994-2004 were reviewed. The study design was a retrospective analysis of data collected from one hospital. Prognostic factors were identified by Student's t-test and χ²- test. Independent predictors of 30-day mortality were determined by the logistic regression method. An outcome score based on a combination of these predictors was developed with weighting of independent predictors based on strength of association. Results: The overall 30-day mortality rate was 67.3%. Prognostic factors independently associated with mortality were the Glasgow Coma Scale score (P < 0.001), age ≥70 years (P = 0.032), systolic blood pressure <130 mmHg or ≥200 mmHg (P = 0.016), ICH volume ≥30 mL (P = 0.012), presence of intraventricular haemorrhage (P = 0.004) and serum glucose ≥8.8 mmol/L (P = 0.023). The score was the sum of individual points assigned as follows: Glasgow Coma Scale score 12-15 (0 points), 9-11 (1), 3-8 (4); age <70 years, yes (0), no (2); and systolic blood pressure 130-199 mmHg, yes (0), no (1). The 30-day mortality rate increased steadily with score (P < 0.001). Conclusion: The outcome score is a simple clinical grading scale that allows risk stratification of HD patients presenting with ICH. This scale could be used to design treatment protocols and clinical research studies of ICH in HD patients.