Keywords
mortality
prognostic factors
ICH score
survival
intensive care
How to Cite
Abstract
Introduction
Spontaneous intracerebral hemorrhage (sICH) is associated with high mortality, particularly in resource-limited settings. The performance of the Intracerebral Hemorrhage (ICH) score remains insufficiently documented in sub-Saharan Africa.
Purpose
This study aimed to identify factors associated with mortality and evaluate the discriminative performance of the ICH score in intensive care units in Kinshasa.
Methods
A multicenter observational cohort study was conducted in 58 patients with computed tomography (CT)-confirmed sICH. Mortality predictors were assessed using Cox proportional hazards regression and Firth penalized logistic regression. Survival was analyzed using Kaplan–Meier methods, and the discriminative performance of the ICH score was evaluated using receiver operating characteristic (ROC) curve analysis.
Results
The mean age was 56.7±12.3 years, and 60.3% of patients were female. Overall mortality was 65.5%. Mechanical ventilation was independently associated with mortality (adjusted hazard ratio [aHR] = 24.43; 95% confidence interval [CI]: 2.92–204.57; p=0.003). In the Firth penalized logistic regression model, an ICH score ≥3 was not independently associated with 30-day mortality (odds ratio [OR] = 3.00; 95% CI: 0.66–13.69; p=0.156). Median survival was shorter among patients with an ICH score ≥3 than among those with an ICH score <3 (5 vs. 8 days; log-rank p=0.009). The ICH score showed moderate discriminative ability (area under the curve [AUC] = 0.714). At a threshold of ≥3, sensitivity was 57.9%, specificity 85.0%, positive predictive value (PPV) 88.0%, and negative predictive value (NPV) 53.1%.
Conclusion
Mortality was high among patients with sICH admitted to intensive care units in Kinshasa. Mechanical ventilation was independently associated with mortality and should be interpreted primarily as a marker of severe illness. The ICH score demonstrated moderate discriminative ability, with relatively high specificity but limited sensitivity at a threshold of ≥3. It may support early risk stratification but should complement, rather than replace, comprehensive clinical assessment.
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Copyright (c) 2026 Ebondo, I., Mbuyi, F., Ilunga, J.-P., Kandongo, D., Kwama, H., Kam, E., Ngoyi, P., Mukuna, P., Buti, O., Ngoy, H., Mbombo, W., Bula Bula, M., Nsiala, J., Barhayiga, B.