Introduction: Triggers for admission to the intensive care unit for patients with intracerebral hemorrhage (ICH) are unclear.
Objectives: To determine the predictors of admission to the intensive care unit (ICU), factors associated with prolonged ICU stay and with long-term outcome in patients with ICH.
Methods: INTERACT2 was an international, open, blinded endpoint, randomized controlled trial of 2839 patients with spontaneous ICH (<6 hours) and elevated systolic blood pressure (SBP) who were allocated to receive intensive (target SBP <140mmHg) or guideline-recommended (target SBP <180mmHg) blood pressure lowering treatment. Demographic, clinical and radiological indicators associated with an ICU admission, prolonged ICU stay, and poor functional outcome at 90 days were identified by multivariable logistic regression models.
Results: Younger age, prior stroke, severe clinical deficit, large ICH volume, intraventricular hemorrhage (IVH), early neurological deterioration as well as need for intubation and surgical intervention were identified as predictors for an admission to the ICU. For patients who were admitted to the ICU, those with prior antihypertensive medication, severe clinical deficit, early deterioration, ICH volume ≥15 ml, lobar ICH location, IVH, who underwent intubation or surgical procedures required ICU stays longer. Older age, severe clinical deficit, early deterioration, shorter time to randomization, ICH volume ≥15 ml, and requirement for intubation and surgical intervention were associated with major disability or mortality at 90 days.
Conclusions: Future plans for risk stratification of ICU admissions for ICH patients may include assessment of ICH volume, presence of IVH, NIHSS, need for intubation along with the age factor.