ICH Score and Basal Plasma D-Dimer in Patients with Intracerebral Haemorrhage.

Corresponding Author:
Dr. Maruthi R.,
#50a, Old Honnali Road,
Near Huchyraya Swamy Temple,
Shikaripur Shikaripur Taluk Shimoga(D)
577427, Karnataka, India.
E-mail: maruthir1984@gmail.com

ABSTRACT

BACK GROUND

Intracerebral haemorrhage constitutes 10-20 % of all strokes & remains without treatment of proven benefit & has higher risk of morbidity & mortality than cerebral infarction or subarachnoid bleed. Thus, these models may accurately predict outcome, and hence the purpose of this study is to define a clinical grading scale for patients with ICH which uses criteria that are predictive of outcome & that can be rapidly & accurately assessed at the time of presentation in emergency/casualty. Estimation of basal plasma D-dimer levels an indicator of systemic activation of coagulative & fibrinolytic system has shown to a powerful predictor of both early neurological worsening & mortality outcome & hence the present study is undertaken.

METHODS

The study was carried out in the IPD of Department of General Medicine, Basaveshwara Teaching and General Hospital, Kalaburagi, attached to Mahadevappa Rampure Medical College. It is a cross sectional study conducted among 100 intracerebral bleed patients between November 2018 to November 2019 with simple random sampling procedure. Patients were followed up at the end of 1 month with telephone/letter/email.

RESULTS

The mortality among patients who scored 0 of ICH scale was 0%, ICH score of 1 was 13.6 %, ICH score of 5 was 100 %. No patient scored 6. Higher the ICH score, higher is the mortality. Mortality among patients with D-Dimer value between 1500 – 5000 ng/ml is 55.2 %, and > 5000 ng/ml is 92.3 %. Above table indicates that higher the basal level of D-Dimer value higher is the mortality. Mortality among patients of either sex was equal i.e., 50 % between 8 - 15 days, and no deaths were noted between 15 - 30 days.

CONCLUSIONS

Intracerebral haemorrhage (ICH) has remained a serious disease despite recent improvements in management. So, efforts must be directed towards better understanding and modification of risk factors. The major risk factor in our study was hypertension. The other common risk factors were alcohol consumption and smoking. Thus, measures to ensure adequate control of hypertension/compliance of treatment among hypertensive, abstinence from alcohol and smoking may reduce the incidence of ICH. High initial plasma D-Dimer levels would indicate bad prognosis in ICH. In addition to diagnosis of ICH, CT Scan can also be used as a useful tool in assessing prognostic outcome of ICH, by using radiological parameters like larger volume of haematoma, presence of midline shift, intraventricular extension of haemorrhage and hydrocephalus which indicated bad prognosis i.e., using ICH score, higher the ICH score higher is the mortality.

KEY WORDS

Intracerebral Haemorrhage, ICH Score, Basal Plasma D-Dimer, Risk Stratification, GCS Score