Predictors of early neurological deterioration and in-hospital mortality among patients with spontaneous intracerebral hemorrhage in a tertiary referral center in Ethiopia: a retrospective cohort study

<title>Abstract</title> <p>Background: Spontaneous intracerebral hemorrhage (sICH) causes severe morbidity and mortality globally, but its burden is disproportionately borne by low- and middle-income countries where access to specialized stroke care is highly restricted. While early neurological deterioration (END) is a critical driver of poor functional outcomes, the clinical and radiological predictors of both END and in-hospital mortality (IHM) remain profoundly understudied in sub-Saharan Africa. Identifying these determinants is vital for real-time risk stratification and triaging scarce neurocritical care resources. This study establishes the predictors of END and IHM among patients with sICH at a major tertiary referral hospital in Ethiopia, providing actionable evidence to guide acute stroke management in resource-limited settings Methods We conducted a retrospective cohort study among 112 adult patients with computed tomography-confirmed sICH admitted to Tikur Anbessa Specialized Hospital, Ethiopia, between January 2022 and December 2025. END was defined as a decline of ≥ 4 points in the Glasgow Coma Scale (GCS) score within 24 h of presentation. Bivariable and multivariable logistic regression analyses were performed to identify independent predictors of END and IHM. Results Among 112 patients, 40 (35.7%) experienced END and 30 (26.8%) died during hospitalization. Prior anticoagulant use, prolonged onset-to-admission time, intraventricular extension, and renal dysfunction were independently associated with END. Independent predictors of IHM included admission GCS score (AOR = 0.75 (95% CI: 0.65–0.88), hemorrhage location (AOR = 0.15; 95%CI: 0.041–0.590), elevated creatinine level (AOR = 2.45 (95% CI: 1.20–5.00), prior anticoagulant use (AOR = 0.21; 95%CI: 0.051–0.876), and the occurrence of in-hospital complications (AOR = 0.72; 95%CI: 0.573–0.916). Patients who developed END had significantly higher mortality than those without (χ² = 17.10, p &lt; 0.001). Conclusions More than one-third of patients with sICH experienced END, and over one-quarter died during hospitalization. Clinical severity at presentation, anticoagulant exposure, intraventricular extension, and renal dysfunction were significant predictors of poor outcomes. These findings highlight the need for early risk stratification, standardized neuromonitoring, and targeted interventions for patients with sICH in resource-limited tertiary care settings</p>