Stroke-Withdrawal of life-sustaining treatment, patients with intracerebral hemorrhage with impaired consciousness have increased mortality

Intracerebral hemorrhage (ICH) is associated with high mortality in the early and late stages (40% and 55%, respectively)
.

However, after severe acute brain injury, more than one-third of patients can achieve independence within 6 to 12 months of follow-up

However, after severe acute brain injury, more than one-third of patients can achieve independence within 6 to 12 months of follow-up

Rejection or withdrawal of life-sustaining treatment (WOLST) is very common and is driven by beliefs about poor prognosis; this leads to a self-fulfilling prophecy for patients who may have reasonable neurological outcomes if actively treated
.

The current prognostic model is biased because it does not take WOLST into account

In this way, Ayham Alkhachroum of the University of Miami and others used the data from the Florida Stroke Registry (FSR) Hospital that participated in the Get With The Guidel-Stroke of the American Heart Association to assess the impact of loss of LOC on the outcome and its time trend at the onset of ICH.

.

It is also assumed that the loss of LOC on admission is related to the high mortality rate after ICH and is affected by the decision to suspend or withdraw life-sustaining treatment

From 2010 to 2019, ICH patients from 121 Florida hospitals who participated in Florida stroke registration were included
.

They studied the impact of LOC at the time of onset on in-hospital mortality (main outcome), WOLST, walking status at discharge, length of stay in hospital, and discharge management

Among 37 613 patients with ICH (mean age 71 years, 46% were women, 61% were white, 20% were black, and 15% were Hispanics), 12 272 (33%) had LOC impaired at the time of onset
.

Compared with the cases of preserving LOC, patients with impaired LOC are older (72 years old vs.

In the multivariate logistic regression of the generalized estimating equation that takes into account basic demographics, comorbidities, severity of ICH, hospital size, and teaching status, loss of LOC is associated with higher mortality (odds ratio, 3.
7[95% CI, 3.
1-4.
3], P<0.
0001) is related to the lower probability of being discharged home or recovering (odds ratio, 0.
3[95% CI, 0.
3-0.
4], P<0.
0001)
.

WOLST significantly mediates the impact of LOC impairment on mortality (mediation effect, 190[95%CI, 152-229], P<0.
0001)
.

51% of patients have early WOLST (<2 days)

WOLST significantly mediates the impact of impaired LOC on mortality

After the 2015 American Heart Association/American Stroke Association Intangible Cultural Heritage Guidelines recommended active treatment and opposed early non-rescue, a reduction in early WOLST was observed in patients with compromised LOC
.

Stroke

In this large multicenter stroke register, one-third of ICH cases showed impaired LOC
.

Loss of LOC is related to higher in-hospital mortality and worse discharge management, which is mainly affected by the early decision to suspend or WOLST

Loss of LOC is related to higher in-hospital mortality and worse discharge management, which is mainly affected by the early decision to suspend or WOLST

Withdrawal of Life-Sustaining Treatment Mediates Mortality in Patients With Intracerebral Hemorrhage With Impaired Consciousness.
Stroke Withdrawal of Life-Sustaining Treatment Mediates Mortality in Patients With Intracerebral Hemorrhage With Impaired Consciousness.
Stroke

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