Long-term mortality in survivors of spontaneous intracerebral hemorrhage

Abstract

Background Factors associated with long-term mortality after spontaneous intracerebral hemorrhage (ICH) have been poorly investigated. Aim Our objective was to identify variables associated with long-term mortality in a prospective cohort of 30-day ICH survivors. Methods We prospectively included consecutive 30-day spontaneous ICH survivors. We evaluated baseline and follow-up clinical characteristics and magnetic resonance imaging (MRI) markers of chronic brain injury as variables associated with long-term mortality using univariate and multivariable Cox proportional hazard regression models. Results Of 560 patients with spontaneous ICH, 304 (54.2%) survived more than 30 days and consented for follow-up. During a median follow-up of 10 years (interquartile range: 8.0–10.5), 176 patients died. The cumulative survival rate at 10 years was 38%. In multivariable analysis, variables independently associated with long-term mortality were age (hazard ratio (HR) per 10-year increase: 1.68, 95% confidence interval (CI): 1.45–1.95), male gender (HR: 1.41, CI: 1.02–1.95), prestroke dependency (HR: 1.66, CI: 1.15–2.39), National Institutes of Health Stroke Scale score (HR per 1-point increase: 1.03, CI: 1.01–1.04), occurrence of any stroke (HR: 2.24, CI: 1.39–3.60), and dementia (HR: 1.51, CI: 1.06–2.16) during follow-up. Among MRI markers, only cerebral atrophy (HR per 1-point increase: 1.50, CI: 1.13–2.00) was independently associated with long-term mortality. Conclusions Preexisting comorbidities, clinical severity at presentation, and significant clinical event during follow-up are associated with long-term mortality. Among MRI markers of chronic brain injury, only cerebral atrophy is associated with long-term mortality.

Paeonol inhibits the progression of intracerebral haemorrhage by mediating the HOTAIR/UPF1/ACSL4 axis

“…People who undergo ICH treatment have a high incidence of recurrent haemorrhagic stroke, which accounts for a significant elevation in incidence compared with those who first suffer from ICH (Chu et al, 2020). Previous studies have confirmed that the high-risk factors related to ICH are lobar haematoma location, race/ethnicity and apolipoprotein (APOE) gene mutations (chiefly cortical superficial siderosis and cerebral microbleeds) (Lorente et al, 2020;Pasi et al, 2020;Sykora et al, 2020). Since ICH seriously threatens the health of elderly people, it is urgent to develop a new method for the treatment of ICH.…”

Long-term mortality in young patients with spontaneous intracerebral haemorrhage: Predictors and causes of death

“…Both pre-stroke dependency and cerebral global atrophy were found to be predictors of long-term mortality in the PITCH cohort when including 30-day survivors of all ages, as well as higher age, male sex, higher NIHSS at baseline and any recurrent stroke or dementia during follow-up. 18 In these young 30-day ICH survivors, cerebral atrophy was the only radiological predictor of long-term mortality. An explanation could be that cerebral atrophy can be considered as an expression of severe brain damage secondary to both cerebral small vessel disease and neurodegeneration (e.g.…”

“…Excessive alcohol consumption was not found to be predictive of long-term mortality in the PITCH cohort of all ages and therefore may be specific to this young subgroup of this cohort. 18 Previously, excessive alcohol consumption has been shown to be associated with a higher mortality risk in ICH patients of all ages. 11,22 The Finnish hospital-based study found male sex and diabetes at baseline to be predictors of long-term mortality, however they did not take alcohol use, mRS pre-ICH or MRI-markers into account.…”

“…Fourth, we acknowledge a partial overlap between this cohort and the one of a recent published study. 18 However, the target population and research question are different.…”

“…All patients were followed up at 6 months, 12 months and annually thereafter. 18 For this study, we retrospectively obtained the causes of death through medical records, contact with general practitioners (GP) or other physicians listed in the medical records. We classified the primary causes of death into four categories, according to a previously reported classification: 19 vascular deaths (recurrent ICH, ischaemic stroke, other), non-vascular deaths and death from an unknown cause due to lack of information.…”