Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage
Journal Paper/Review - May 31, 2022
Goeldlin Martina B, Mueller Achim, Siepen Bernhard M, Mueller Madlaine, Strambo Davide, Michel Patrik, Schaerer Michael, Cereda Carlo W, Bianco Giovanni, Lindheimer Florian, Berger Christian, Medlin Friedrich, Backhaus Roland, Peters Nils, Renaud Susanne, Fisch Loraine, Niederhaeuser Julien, Carrera Emmanuel, Dirren Elisabeth, Bonvin Christophe, Sturzenegger Rolf, Kahles Timo, Nedeltchev Krassen, Kägi Georg, Vehoff Jochen, Rodic Biljana, Bolognese Manuel, Schelosky Ludwig, Salmen Stephan, Mono Marie-Luise, Polymeris Alexandros A, Engelter Stefan T, Lyrer Philippe, Wegener Susanne, Luft Andreas R, Z'Graggen Werner, Bervini David, Volbers Bastian, Dobrocky Tomas, Kaesmacher Johannes, Mordasini Pasquale, Meinel Thomas R, Arnold Marcel, Fandino Javier, Bonati Leo H, Fischer Urs, Seiffge David J, SSR Investigators
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.