Radiological and Biochemical Predictors of Early Neurological Deterioration in Patients with Spontaneous Intracerebral Hemorrhage: A Prospective Cohort Study

Abstract

Background: Poor functional outcome and high mortality rates are associated with neurological deterioration in the early phase of spontaneous intracerebral hemorrhage (ICH). Identifying patients at high risk for rapid deterioration after admission could allow for increased surveillance, repeated reassessment, and prompt escalation of care.

Objectives: To determine the risk factors for early neurological deterioration (END) from spontaneous intracerebral hemorrhage (ICH) on radiologic and biochemical admission variables alone and to explore the discriminatory power of a model combining both radiologic and biochemical variables.

Methods: This prospective cohort study enrolled 150 adults with spontaneous ICH confirmed by computed tomography between January 2025 and January 2026 at two neurosurgical centers in Punjab, Pakistan. Clinical characteristics at presentation, non-contrast brain CT findings, and routinely obtained laboratory measurements were recorded. END was defined as an increase of ≥4 points on NIHSS and/or a decrease of≥2 points on GCS within 24 hours. Independent associations were estimated by multivariable logistic regression, and receiver operating characteristic analysis was used to compare the discriminative ability of the prediction models.

Results: 44 of 150 patients (29.3%) experienced END. Compared with neurologically stable patients, those who deteriorated had a larger hematoma burden and more frequent intraventricular extension, blend sign, midline shift, and subsequent hematoma expansion; they also showed higher NLR, CRP, glucose, and D-dimer values. Independent predictors were hematoma volume >30 mL (aOR 3.12), intraventricular hemorrhage (aOR 2.47), blend sign (aOR 2.74), NLR >7.5 (aOR 2.38), CRP >10 mg/L (aOR 2.29), and GCS ≤10 (aOR 2.56). The model integrating radiological and biochemical information achieved an AUC of 0.86, with sensitivity of 81.8% and specificity of 78.3%.

Conclusion: Early deterioration after spontaneous ICH was independently associated with routinely visible CT markers and readily available inflammatory indices. A joint radiological-biochemical approach provided stronger early risk discrimination than either domain considered alone.