Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage
Wissenschaftlicher Artikel/Review - 31.05.2022
SSR Investigators, Luft Andreas R, Wegener Susanne, Lyrer Philippe, Engelter Stefan T, Polymeris Alexandros A, Mono Marie-Luise, Salmen Stephan, Schelosky Ludwig, Bolognese Manuel, Rodic Biljana, Z'Graggen Werner, Bervini David, Seiffge David J, Fischer Urs, Bonati Leo H, Fandino Javier, Arnold Marcel, Meinel Thomas R, Mordasini Pasquale, Kaesmacher Johannes, Dobrocky Tomas, Volbers Bastian, Vehoff Jochen, Kägi Georg, Berger Christian, Lindheimer Florian, Bianco Giovanni, Cereda Carlo W, Schaerer Michael, Michel Patrik, Strambo Davide, Mueller Madlaine, Siepen Bernhard M, Mueller Achim, Medlin Friedrich, Backhaus Roland, Nedeltchev Krassen, Kahles Timo, Sturzenegger Rolf, Bonvin Christophe, Dirren Elisabeth, Carrera Emmanuel, Niederhaeuser Julien, Fisch Loraine, Renaud Susanne, Peters Nils, Goeldlin Martina B
BACKGROUND AND PURPOSE
Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce.
We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019).
We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031).
Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage.