Predictors of Spontaneous Intracerebral Hemorrhage Mortality: a Community-based Study in Brno, Czech Republic

Overview

Journal Acta Neurol Belg

Publisher Springer

Specialty Neurology

Date 2024 Aug 5

PMID 39102105

Authors

Albert Sterba

Petra Sedova

Robert D Brown Jr

Albert Stehlik

Tomas Bryndziar

Petra Cimflova

Miroslav Zvolsky

Silvie Belaskova

Ingrid Kovacova

Josef Bednarik

Robert Mikulik

Affiliations

Soon will be listed here.

Abstract

Background And Objective: Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH.

Methods: We identified all patients admitted with spontaneous ICH to hospitals with a certified stroke unit in Brno, the second largest city in the Czech Republic (CR), in 2011, the year of the Czech Population and Housing Census. We reviewed their medical records for risk factors, radiographic parameters, and measures of post-stroke neurological deficit [National Institutes of Health Stroke Scale (NIHSS)]. Using the dates of death from the Czech National Mortality Register, we calculated mortality at 30 days, six months, one year, and three years after the ICH. Multivariate analysis with forward stepwise logistic regression was performed to determine independent predictors of mortality (p < 0.05).

Results: In 2011, 1086 patients with stroke were admitted to the four stroke-certified hospitals in Brno, CR. Of these, 134 had spontaneous ICH, with complete data available in 93 of them entering the final analysis. The mortality at 30 days, 6 months, 1 year, and 3 years post-ICH was 34%, 47%, 51%, and 63%, respectively. The mortality was highest in the first few days post-event, with 50% of patients dying in 255 days and average survival being 884 ± 90 days. Both NIHSS and modified ICH (MICH) score showed to be strong and reliable predictors of short- as well as long-term mortality; the risk of death post-ICH increased with older age and size of ICH. Other risk factors contributing to higher, primarily shorter-term mortality included history of cardiac failure, myocardial infarction, or atrial fibrillation.

Conclusions: In our community-based study, we found that severity of neurological deficit at admission (NIHSS), combined with age and size of ICH, well predicted short- as well as long-term mortality after spontaneous ICH. A history of cardiac failure, myocardial infarction, or atrial fibrillation at presentation were also predictors of mortality, underscoring the need for optimal cardiac management in patients with ICH.

References

van Asch C, Luitse M, Rinkel G, van der Tweel I, Algra A, Klijn C . Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010; 9(2):167-76. DOI: 10.1016/S1474-4422(09)70340-0. View

Slow E, Hamani C, Lozano A, Poon Y, Moro E . Deep brain stimulation for treatment of dystonia secondary to stroke or trauma. J Neurol Neurosurg Psychiatry. 2014; 86(9):1046-8. DOI: 10.1136/jnnp-2014-308943. View

Sedova P, Brown R, Zvolsky M, Kadlecova P, Bryndziar T, Kubelka T . Incidence of Hospitalized Stroke in the Czech Republic: The National Registry of Hospitalized Patients. J Stroke Cerebrovasc Dis. 2016; 26(5):979-986. DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.006. View

Bryndziar T, Sedova P, Brown Jr R, Fiserova E, Zvolsky M, Bednarik J . Trends in One Month and One Year Hemorrhagic Stroke Case Fatality Rates in the Czech Republic between 1998 and 2015. J Stroke Cerebrovasc Dis. 2020; 29(6):104762. DOI: 10.1016/j.jstrokecerebrovasdis.2020.104762. View

Sagan A, Bryndova L, Kowalska-Bobko I, Smatana M, Spranger A, Szerencses V . A reversal of fortune: Comparison of health system responses to COVID-19 in the Visegrad group during the early phases of the pandemic. Health Policy. 2021; 126(5):446-455. PMC: 8527640. DOI: 10.1016/j.healthpol.2021.10.009. View

Bryndziar T, Matyskova D, Sedova P, Belaskova S, Zvolsky M, Bednarik J . Predictors of Short- and Long-Term Mortality in Ischemic Stroke: A Community-Based Study in Brno, Czech Republic. Cerebrovasc Dis. 2021; 51(3):296-303. DOI: 10.1159/000519937. View

Jackova J, Sedova P, Brown Jr R, Zvolsky M, Volna M, Baluchova J . Risk Factors in Ischemic Stroke Subtypes: A Community-Based Study in Brno, Czech Republic. J Stroke Cerebrovasc Dis. 2019; 29(2):104503. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104503. View

Broderick J, Brott T, Duldner J, Tomsick T, Huster G . Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993; 24(7):987-93. DOI: 10.1161/01.str.24.7.987. View

10.

Gebel Jr J, Jauch E, Brott T, Khoury J, Sauerbeck L, Salisbury S . Relative edema volume is a predictor of outcome in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke. 2002; 33(11):2636-41. DOI: 10.1161/01.str.0000035283.34109.ea. View

11.

Nag C, Das K, Ghosh M, Khandakar M . Prediction of Clinical Outcome in Acute Hemorrhagic Stroke from a Single CT Scan on Admission. N Am J Med Sci. 2012; 4(10):463-7. PMC: 3482777. DOI: 10.4103/1947-2714.101986. View

12.

Hallevi H, Dar N, Barreto A, Morales M, Martin-Schild S, Abraham A . The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med. 2009; 37(3):969-74, e1. PMC: 2692316. DOI: 10.1097/CCM.0b013e318198683a. View

13.

Sreekrishnan A, Dearborn J, Greer D, Shi F, Hwang D, Leasure A . Intracerebral Hemorrhage Location and Functional Outcomes of Patients: A Systematic Literature Review and Meta-Analysis. Neurocrit Care. 2016; 25(3):384-391. DOI: 10.1007/s12028-016-0276-4. View

14.

Diringer M, Edwards D, Zazulia A . Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke. 1998; 29(7):1352-7. DOI: 10.1161/01.str.29.7.1352. View

15.

Witsch J, Neugebauer H, Zweckberger K, Juttler E . Primary cerebellar haemorrhage: complications, treatment and outcome. Clin Neurol Neurosurg. 2013; 115(7):863-9. DOI: 10.1016/j.clineuro.2013.04.009. View

16.

Cheung R, Eliasziw M, Meldrum H, Fox A, Barnett H . Risk, types, and severity of intracranial hemorrhage in patients with symptomatic carotid artery stenosis. Stroke. 2003; 34(8):1847-51. DOI: 10.1161/01.STR.0000080523.29138.5F. View

17.

Satopaa J, Mustanoja S, Meretoja A, Putaala J, Kaste M, Niemela M . Comparison of all 19 published prognostic scores for intracerebral hemorrhage. J Neurol Sci. 2017; 379:103-108. DOI: 10.1016/j.jns.2017.05.034. View

18.

Cheung C, Tsoi T, Hon S, Au-Yeung M, Shiu K, Lee C . Using the National Institutes of Health Stroke Scale (NIHSS) to predict the mortality and outcome of patients with intracerebral haemorrhage. Hong Kong Med J. 2008; 14(5):367-70. View

19.

Bandettini Di Poggio M, Finocchi C, Brizzo F, Altomonte F, Bovis F, Mavilio N . Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome. Neurol Sci. 2018; 40(2):319-326. DOI: 10.1007/s10072-018-3644-3. View

20.

Hillman J, Fridriksson S, Nilsson O, Yu Z, Saveland H, Jakobsson K . Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study. J Neurosurg. 2002; 97(4):771-8. DOI: 10.3171/jns.2002.97.4.0771. View

21.

Suo Y, Chen W, Pan Y, Peng Y, Yan H, Zhao X . The max-intracerebral hemorrhage score predicts long-term outcome of intracerebral hemorrhage. CNS Neurosci Ther. 2018; 24(12):1149-1155. PMC: 6489715. DOI: 10.1111/cns.12846. View