Predictors of Early Deterioration and In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage at Tikur Anbessa Specialized Hospital: A Retrospective Study, Jan 2022 – Dec 2025
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Date
2026
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Addis Ababa Uinverstiy
Abstract
Background: Spontaneous intracerebral hemorrhage causes high rates of early deterioration and death. These outcomes remain major clinical challenges in acute stroke care. However, predictors of early deterioration and in-hospital death are not fully established, particularly in local or resource-limited settings. Identifying these predictors may improve early risk stratification, monitoring and treatment decisions.
Objective: To assess the proportion and predictors of early neurological deterioration and in-hospital mortality among spontaneous intracerebral hemorrhage patients.
Methods: A cross-sectional study was undertaken at a teritiary care center among 112 patients with spontaneous intracerebral hemorrhage admitted between January 2022 to December 2025 to Tikur Anbessa Specialized Hospital. Early neurologic deterioration was defined by a decrease in a GCS by ≥4 points within 24 hours of presentation. In-hospital death was recorded at discharge. Bivariable logistic regression identified candidate predictors with p less than 0.25. Multivariable logistic regression with backward elimination identified independent predictors. Adjusted odds ratios with 95 percent confidence intervals were reported. Model fitness was assessed using Hosmer and Lemeshow goodness-of-fit test.
Results: Early deterioration observed in 40 patients (35.7%), and in-hospital mortality occurred in 30 patients(26.8%). Independent predictors of early deterioration included intervention type, intraventricular extension, serum creatinine level, onset to admission time, and prior anticoagulant use. Prior anticoagulant use increased the odds of deterioration by more than eight times, while higher serum creatinine levels were also associated with increased risk. Independent predictors of in-hospital mortality included increased serum creatinine level, in-hospital complications, prior anticoagulant use, admission Glasgow Coma Scale score, and hemorrhage location. Lower admission Glasgow Coma Scale score showed strong association with mortality.
Conclusion: Early deterioration and in-hospital mortality occurred in a significant proportion of those with spontaneous intracerebral hemorrhage. Clinical status at admission, laboratory findings, imaging features, and treatment factors influenced outcomes. The results highlight the requirement for early risk stratification and close monitoring of patients at increased risk of clinical decline.
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Keywords
Intracerebral hemorrhage, early deterioration, mortality, predictors, Glasgow Coma Scale.