Hyperosmolar therapy is not associated with improved outcomes in patients with large Intracerebral Hemorrhage

Objective: We aimed to evaluate the use of hyperosmolar therapy in patients with larger hematomas who might benefit from treatment targeting mass effect/edema. Background: Spontaneous intracerebral hemorrhage (ICH) is a significant cause of mortality. Design/Methods: Retrospective study of patients with primary ICH from 2012–2015. Inclusion criteria: ≥18 years, ICH volume ≥30cc, and presentation within 12 hours of symptom onset. Exclusion criteria: DNR/I within 12 hours of arrival. Patients were divided into those who received standard care or hyperosmolar therapy (mannitol or hypertonic saline). Primary outcome measure was good outcome as measured by modified Rankin Scale (mRS) Score 0–3 at discharge. The unadjusted and adjusted odds ratio (OR) of experiencing good outcome as well as its 95% confidence interval (CI) in hyperosmolar therapy group compared to standard care group was calculated by logistic regression model. Results: Of 103 patients, 51 received standard care and 52 received hyperosmolar therapy. (Age 63.4±14.8 vs 65.0±14.5, p=0.5955, respectively). There were no significant differences in important baseline characteristics: GCS (median 6 in standard care vs 4 in hyperosmolar therapy, p=0.065), presence of IVH (p=0.4090), location (p=0.7098) and median hematoma volume (51 cc standard care vs 64 cc hyperosmolar therapy, p=0.6329). In the standard care group 26.92% patients vs. 11.76% patients in the hyperosmolar therapy underwent hemicraniectomy (P=0.0518). Good outcome at discharge was seen in 13.5% of standard care vs. 2.0% of hyperosmolar treated patients (unadjusted OR 0.129, 95% CI 0.015–1.086, p=0.0599). After adjusting for platelet transfusion, the results were similar (adjusted OR 0.129, 95% CI 0.015–1.094, p=0.0604). Conclusions: We focused on the severest group of ICH patients with large hematoma and severe deficit on presentation. Our results are consistent with prior investigation and suggest that hyperosmolar therapy may not benefit patients with large ICH. Prospective study is needed as it is becoming common practice to use hyperosmolar therapy in ICH patients. Disclosure: Dr. Alam has nothing to disclose. Dr. Moser has nothing to disclose. Dr. Gonzales has nothing to disclose.