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OBJECTIVE Neurologic death is the most serious consequence of intracranial disease among patients with brain metastases. Identifying patients with brain metastases at increased risk of neurologic death can improve care and guide further research. We sought to delineate factors predictive of neurologic death among patients with brain metastases. METHODS We identified 1,218 patients with newly diagnosed brain metastases managed at Brigham and Women's Hospital/Dana-Farber Cancer Institute from 2008-2015. Factors predictive of neurologic death were assessed via univariable and multivariable Fine and Gray competing risks regression. RESULTS On multivariable analysis, neurologic death was associated with number of brain metastases (hazard ratio [HR] 1.01 per 1 metastasis increase, 95% CI 1.01-1.02, p<0.001) and three primary tumor sites (reference=non-small cell lung cancer): melanoma (HR 4.67, 95% CI 3.27-6.68, p<0.001), small cell lung cancer (HR 2.33, 95% CI 1.47-3.68, p<0.001), and gastrointestinal cancer (HR 2.21, 95% CI 1.28-3.82, p=0.005). Conversely, a reduction in neurologic death was found in patients with good Karnofsky performance status (90-100 versus 30-80, HR 0.67, 95% CI 0.48-0.95, p=0.03) and progressive extracranial metastases at diagnosis of intracranial disease (HR 0.50, 95% CI 0.38-0.67, p<0.001). Among patients with breast primaries, HER2+ patients displayed increased neurologic death relative to the reference of HR+/HER2- (univariable analysis only: HR 2.41, 95% CI 1.00-5.84, p=0.05). CONCLUSIONS Patients with melanoma, small cell lung cancer, gastrointestinal, and HER2+ breast cancer primaries, as well as greater intracranial versus extracranial disease burden, harbor significant risk of neurologic death. Future research investigating novel intracranial approaches should focus on these populations.