Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department

Introduction: Intracranial hemorrhage is a devastating complication of cancer and its treatment. Objective: To evaluate the characteristic, risk factors and clinical outcomes in cancer patients with intracranial hemorrhage presenting to the emergency department. Methods: : We collected a decade of retrospective data on all patients with the diagnosis of ICH who visited The University of Texas MD Anderson Cancer Center emergency department. Logistic regression analyses were used to determine the association between clinical variables and various outcomes. Results: : 704 confirmed acute ICH cases were identified. Of these, 576 (81.8%) were spontaneous. In-hospital, 7-day, and 30-day mortality rates were 15.1%, 11.4%, and 25.6%, respectively. Hypertension was most predictive of prolonged hospital stay ( [OR]=4.77, 95% [CI]=1.30-22.70, P =0.045) and intensive care unit admission (OR=1.52, 95% CI=1.09-2.12, P =0.013). Low platelet count was associated with both in-hospital mortality (OR=0.96, 95% CI=0.94-0.99, P =0.008) and 30-day mortality (OR=0.98, 95% CI=0.96-1.00, P =0.016). Radiologic findings especially herniation and hydrocephalus, were strong predictors of short-term mortality. Patients with intratumor bleeding had substantially lower short-term mortality rates, but this did not reach statistical significance. Conclusions: : Intracranial hemorrhage remains an uncommon complication in cancer patients. The risk factors most helpful in predicting outcomes were hypertension, low platelet count, and hydrocephalus or herniation on imaging.