An Early Rehabilitation Favors the Prognosis of Hypertensive Intracerebral Hemorrhage With Acute Disorders of Consciousness: A Retrospective Cohort Study With Propensity Score Matching

TL;DR

Early rehabilitation improves neurological outcomes and reduces cognitive impairment in patients with hypertensive brain hemorrhage and altered consciousness.

Contribution

This study demonstrates that early rehabilitation improves prognosis and reduces cognitive dysfunction in hypertensive intracerebral hemorrhage patients with acute disorders of consciousness.

Findings

Early rehabilitation significantly reduced mechanical ventilation duration in HICH patients with acute DoC.

Early rehabilitation improved neurological outcomes, with higher modified Rankin Scale scores in the ER group.

Early rehabilitation reduced cognitive impairment in patients who regained consciousness after 3 months.

Abstract

Objective: There currently lacks the prognosis assessment of hypertensive intracerebral hemorrhage (HICH) with acute disorders of consciousness (DoC) after early rehabilitation (ER). The present study aims to investigate the outcomes of consciousness and neurological and cognitive functions in HICH patients with acute DoC intervened with ER via a retrospective cohort study with propensity score matching (PSM).

Methods: A total of 265 eligible HICH patients with acute DoC admitted to the First Affiliated Hospital with Nanjing Medical University from January 2021 to December 2023 were retrospectively recruited. They were randomly divided into the ER group (n = 115) and the nonER group (n = 150) before PSM. After the PSM at a ratio of 1:1, 96 patients were allocated to each group. Baseline characteristics before and after PSM were compared between the ER group and the nonER group. Outcome measures included the duration of mechanical ventilation, and proportions of participants with an emergence to a conscious state (eMCS), 0–3 points of the modified Rankin Scale (mRS), and cognitive impairment.

Results: Baseline characteristics were comparable between the ER group and the nonER group after PSM (p ≥ 0.05). An ER significantly shortened the duration of mechanical ventilation (9 days vs. 10 days, p=0.022). The neurological prognosis at 3 months of HICH combined with acute DoC was significantly improved by the ER, with a significantly higher proportion of participants grading 0–3 points of the mRS in the ER group than the nonER group (57.3% vs. 40.6%, p=0.021). Among 174 participants who restored consciousness at 3 months of onset, a significantly lower proportion of cognitive impairment was detected in the ER group than the nonER group (25.8% vs. 53.2%, p=0.002).

Conclusion: An ER shortens the duration of mechanical ventilation and improves the neurological prognosis in HICH patients with acute DoC. Although the outcome of consciousness is unable to be improved, an ER does reduce the risk of residual cognitive dysfunction in HICH patients with acute DoC.

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