Predicting 30-Day Outcomes in Primary Intracerebral Hemorrhage Using the Intracerebral Hemorrhage Score: A Study in Bangladesh

Introduction Intracerebral hemorrhage (ICH) is a severe subtype of stroke associated with high rates of mortality and morbidity. Accurate early prognostication is essential for optimizing treatment strategies and improving patient outcomes. The ICH score, which includes clinical and imaging variables, is widely used to predict mortality and functional outcomes in ICH patients. However, limited data on the applicability of this scoring system are available from low-income countries. This study aims to evaluate the ICH score as a predictor of 30-day mortality and functional outcome, as measured by the modified Rankin Scale (mRS), in ICH patients at a tertiary care hospital in Bangladesh. Methods We conducted a prospective cohort study over one year at the National Institute of Neurosciences and Hospital in Dhaka, Bangladesh. One hundred patients aged over 18 years with confirmed primary ICH were enrolled. We collected data on demographics, clinical presentation, risk factors, and imaging findings, including the Glasgow Coma Scale (GCS), ICH score components, and hematoma volume. Patients were followed up for 30 days, and outcomes were assessed using the mRS. Statistical analyses included univariate and multivariate logistic regression and Kaplan-Meier survival estimates. Results A total of 100 participants were enrolled for the study. The mean age of participants was 59.2 ± 14.5 years, and 57 were men, and 43 were women. The overall 30-day mortality rate was 44%. Mortality rates increased significantly with higher ICH scores (p < 0.001), with all patients scoring 4 or 5 on the ICH score dying within 30 days. Lower GCS scores, larger hematoma volumes, the presence of intraventricular hemorrhage (IVH), and increasing age were associated with higher mortality. Multivariate analysis identified increasing age (p = 0.023), lower GCS score (p = 0.003), and higher ICH score (p = 0.025) as independent predictors of 30-day mortality. Higher ICH scores were also significantly associated with poor functional outcomes (mRS ≥ 4) at both discharge and 30 days (p < 0.001). GCS score emerged as an independent predictor of poor functional outcomes at 30 days (p = 0.012). Conclusions The ICH score is an effective tool for predicting 30-day mortality and functional outcomes in patients with primary ICH. Incorporating the ICH score and GCS assessment into routine clinical practice can aid healthcare providers in early risk stratification, optimizing treatment plans, and improving resource allocation.