Advanced Age and Hypoalbuminemia as Complication-related Mortality after 30 Days in Older Patients with Intracerebral Hemorrhage

In Japan, which has become a super-aging society, the incidence of spontaneous intracerebral hemorrhage among older adults is increasing. Managing these patients is often complicated by frailty and systemic comorbidities. Although these issues pose unique challenges, there is limited research on spontaneous intracerebral hemorrhage in this population, leaving their clinical characteristics and prognoses unclear. This retrospective study reviewed spontaneous intracerebral hemorrhage patients aged ≥75 years who were admitted to our institution from April 2004 to March 2024. Demographics, clinical presentation, imaging findings, and in-hospital outcomes were analyzed to identify risk factors for both 30-day and complication-related mortality. A total of 501 patients were included in the study, with 213 (42.5%) categorized as the oldest-old (age ≥85 years). Over the 2-decade study period, the proportion of oldest-old spontaneous intracerebral hemorrhage patients increased, and this age group exhibited a high risk of complication-related mortality (16.9%). Multivariate analysis identified age ≥85 years (odds ratio: 4.25, 95% confidence interval: 2.12-8.51, p < 0.001), Glasgow Coma Scale score ≤8 at admission (odds ratio: 2.27, 95% confidence interval: 1.19-4.34, p = 0.013), and serum albumin ≤3.5 g/dL at admission (odds ratio: 2.12, 95% confidence interval: 1.07-4.19, p = 0.031) as independent risk factors for complication-related mortality. The prognosis of spontaneous intracerebral hemorrhage in older adults is significantly worse in individuals aged ≥85 years. Older patients with spontaneous intracerebral hemorrhage are at a heightened risk of complication-related mortality, which is primarily associated with advanced age, neurological severity, and hypoalbuminemia.