Factors Associated With 30-Day Functional Outcome and Mortality Following Spontaneous Intracerebral Hemorrhage in Bangladesh: A Prospective Two-Center Cohort Study.

Background Spontaneous intracerebral hemorrhage remains a major cause of early mortality and disability worldwide, with a disproportionate burden in low- and middle-income countries such as Bangladesh. However, prospective population-specific data identifying short-term prognostic factors are limited. This study aimed to examine the clinical, radiological, and in-hospital factors associated with 30-day functional outcome and early mortality in a selected two-center cohort of Bangladeshi patients with spontaneous intracerebral hemorrhage. Methods This prospective cohort study was conducted in two tertiary referral centers in Dhaka between February 2021 and January 2023. Adult patients with first-ever spontaneous intracerebral hemorrhage confirmed by computed tomography and presenting within 72 hours were enrolled. Eligibility was restricted to patients with a baseline NIHSS of 5-15, defining a selected, moderate-severity cohort. Baseline demographic, clinical, laboratory, and radiological variables were recorded. Functional outcome at 30 days was assessed using the modified Rankin Scale. Unfavorable functional outcome (mRS 4-6, which includes death) was the primary outcome, and 30-day mortality was a secondary outcome. Multivariable logistic regression was used to examine factors associated with unfavorable outcomes, and Cox proportional hazards models were applied to examine factors associated with 30-day mortality. Results Among 220 patients, 72 (32.7%) died within 30 days, and 130 (59.1%) had unfavorable outcomes at 30 days. Overall, 90 (40.9%) patients had a favorable outcome (mRS 0-3) and 130 (59.1%) had an unfavorable outcome (mRS 4-6), the latter including the 72 deaths. Increasing age was independently associated with poor functional outcome (adjusted OR 1.07 per year; 95% CI 1.04-1.11; p < 0.001). Hemiparesis at admission (OR 7.05; 95% CI 1.65-30.11; p = 0.008), aspiration pneumonia (OR 4.63; 95% CI 1.64-13.10; p = 0.004), and hypernatremia (OR 14.34; 95% CI 2.26-91.16; p = 0.005) were also associated with unfavourable outcome, although aspiration pneumonia and hypernatremia are post-admission complications rather than baseline predictors. For mortality, older age (adjusted HR 1.02; 95% CI 1.00-1.04; p = 0.029) and higher baseline NIHSS (HR 1.23; 95% CI 1.09-1.39; p = 0.001) were independently associated with death, whereas the in-hospital complications aspiration pneumonia (HR 3.34; 95% CI 1.94-5.74; p < 0.001) and hypernatremia (HR 3.30; 95% CI 1.99-5.82; p < 0.001) were associated with higher mortality but, as time-dependent events, should not be interpreted as baseline predictors. Conclusion Advancing age, greater neurological severity, and in-hospital complications such as aspiration pneumonia and hypernatremia were associated with short-term functional outcome and mortality. These associations may help identify high-risk patients, but because this was an observational study of a selected cohort in which in-hospital complications were analyzed as fixed covariates, the findings should not be interpreted as evidence that management of these complications improves outcomes.