BACKGROUND There is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH). PURPOSE We investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome. METHODS We included 825 patients with acute spontaneous non-traumatic ICH, recruited to a prospective multicenter observational study. We evaluated the characteristics associated with critical care admission and poor 6-month functional outcome (modified Rankin Scale, mRS > 3) using univariable (chi-square test and Wilcoxon rank-sum test, as appropriate) and multivariable analysis. RESULTS 286 patients (38.2%) had poor 6-month functional outcome. Seventy-seven (9.3%) patients were admitted to critical care. Patients admitted to critical care were younger (p < 0.001), had lower GCS score (p < 0.001), larger ICH volume (p < 0.001), more often had intraventricular extension (p = 0.008) and underwent neurosurgery (p < 0.001). Critical care admission was associated with poor functional outcome at 6 months (39/77 [50.7%] vs 286/748 [38.2%]; p = 0.034); adjusted OR 2.43 [95%CI 1.36-4.35], p = 0.003), but not with death (OR 1.29 [95%CI 0.71-2.35; p = 0.4). In ordinal logistic regression, patients admitted to critical care showed an OR 1.47 (95% CI 0.98-2.20; p = 0.07) for a shift in the 6-month modified Rankin Scale. CONCLUSIONS Admission to critical care is associated with poor 6-month functional outcome after spontaneous ICH but not with death. Patients admitted to critical care were a priori more severely affected. Although adjusted for main known predictors of poor outcome, our findings could still be confounded by unmeasured factors. Establishing the true effectiveness of critical care after ICH requires a randomised trial with clinical outcomes and quality of life assessments.

中文翻译：

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自发性脑出血后重症监护入院与 6 个月功能结果的相关性

背景 自发性脑出血 (ICH) 后进入重症监护室的临床益处尚不确定。目的 我们调查了自发性 ICH 后与重症监护相关的因素，并评估了重症监护与 6 个月功能结果之间的关联。方法 我们纳入了 825 名患有急性自发性非创伤性 ICH 的患者，这些患者被招募到一项前瞻性多中心观察性研究中。我们使用单变量（卡方检验和 Wilcoxon 秩和检验，视情况而定）和多变量分析评估了与重症监护入院和较差的 6 个月功能结果（改良 Rankin 量表，mRS > 3）相关的特征。结果 286 名患者 (38.2%) 的 6 个月功能结果较差。77 名 (9.3%) 患者被送入重症监护室。入住重症监护室的患者更年轻 (p < 0.001)，GCS 评分较低 (p < 0.001)，ICH 体积较大 (p < 0.001)，脑室内延伸更频繁 (p = 0.008) 并接受了神经外科手术 (p < 0.001) . 入院重症监护与 6 个月时的不良功能结果相关（39/77 [50.7%] vs 286/748 [38.2%]；p = 0.034）；调整后的 OR 2.43 [95%CI 1.36-4.35]，p = 0.003），但与死亡无关（OR 1.29 [95%CI 0.71-2.35；p = 0.4）。在序数逻辑回归中，接受重症监护的患者在 6 个月的改良 Rankin 量表中显示出 OR 1.47 (95% CI 0.98-2.20; p = 0.07)。结论 进入重症监护室与自发性 ICH 后 6 个月的不良功能结果相关，但与死亡无关。接受重症监护的患者先天受到更严重的影响。尽管针对不良结果的主要已知预测因素进行了调整，但我们的研究结果仍可能被未测量的因素混淆。确定 ICH 后重症监护的真正有效性需要一项具有临床结果和生活质量评估的随机试验。