Risk Factors and Predictors of Inpatient mortality Amongst Very Elderly Patients Presenting with Primary Intracerebral Hemorrhage

Introduction: Primary intracerebral hemorrhage (ICH) is known to have poor management outcome. Very elderly patients (age > 80) might have significantly higher incidence of worse management morbidity and mortality after primary ICH. Despite an aging population in many parts of world, the number of studies on outcomes of primary ICH in this age group is limited. The aim of this study was to explore presenting status and pre-existing comorbidities in octogenarians and compare the inpatient management outcomes with younger counterparts.

Methods: The Stony Brook ICH database is a retrospective cohort of 1006 patients that presented with primary ICH from January 2011 to January 2021. Among them, 814 adult patients (age 18-102, mean age = 71 +/- 14.5), with primary ICH were included in this study. In our cohort, 257 patients (31.5%) were over the age of 80 (mean = 85 +/- 9). Demographic data, presenting symptoms, pre-existing medical conditions, and imaging findings were recorded. Inpatient outcomes and functional state presented as modified Rankin Scale (MRS) at discharge were evaluated.

Results: Our results indicate octogenarians had significantly higher baseline MRS and comorbidities such as hypertension, hyperlipidemia, and atrial fibrillation at presentation. Similarly, usage of statins, antiplatelets, and anticoagulants were significantly higher in this age group. Octogenarians were also found to have higher average volume of hematoma at presentation. Our results indicate significantly higher discharge MRS, and inpatient mortality (25.5% vs 16.6%) in older group.

Conclusion : Present study demonstrates a wide variety of pre-existing factors that correlate with worse outcomes amongst octogenarians presenting with primary ICH. Given the importance of aging population as a major healthcare issue in many parts of world, it is crucial to continue exploring these associations in future research. Findings of this study can be utilized to plan further prospective studies on this topic.