Risk Factors Associated With Mortality and Neurologic Disability After Intracerebral Hemorrhage in a Racially and Ethnically Diverse Cohort

• Type of Material: Article
• Authors: Daniel Woo, University of Cincinnati; Mary E Comeau, Wake Forest University; Simone U Venema, Massachusetts General Hospital; Christopher D Anderson, Massachusetts General Hospital; Matthew Flaherty, University of Cincinnati; Fernando Testai, University of Illinois at Chicago; Steven Kittner, University of Maryland; Michael Frankel, Emory University; Michael L James, Duke University; Gene Sung, University of Southern California; Mitchell Elkind, Columbia University; Braford Worrall, University of Virginia; Chelsea Kidwell, University of Arizona; Nicole Gonzales, University of Colorado, Aurora; Sebastian Koch, University of Miami; Christiana Hall, UT Southwestern; Lee Birnbaum, University of Texas at San Antonio; Douglas Mayson, Medstar Georgetown University Hospital; Bruce Coull, University of Arizona; Marc Malkoff, University of Tennessee Health Sciences; Kevin N Sheth, Yale University; Jacob L McCauley, University of Miami; Jennifer Osborne, University of Cincinnati; Misty Morgan, University of Cincinnati; Lee Gilkerson, University of Cincinnati; Tyler Behymer, University of Cincinnati; Elisheva R Coleman, University of Cincinnati; Jonathan Rosand, Massachusetts General Hospital; Padmini Sekar, University of Cincinnati; Charles J Moomaw, University of Cincinnati; Carl D Langefeld, Wake Forest University
• Language: English
• Date: 2022-03-15
• Publisher: AMER MEDICAL ASSOC
• Publication Version: Final Published Version
• Copyright Statement: 2022 Woo D et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2022.1103
• Title of Journal or Parent Work: JAMA NETWORK OPEN
• Volume: 5
• Issue: 3
• Start Page: e221103
• End Page: e221103
• Grant/Funding Information: The study was supported by the National Institute of Neurological Diseases and Stroke (grant No. U01NS069763).
• Keywords: CASE-FATALITY; Life Sciences & Biomedicine; SCORE; LESIONS; Medicine, General & Internal; HEMATOMA VOLUME; DEEP; OUTCOMES; LOBAR; General & Internal Medicine; Science & Technology; PREDICTION
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Rehabilitation and Therapy

Abstract

Introduction: Intracerebral hemorrhage (ICH) is the most severe subtype of stroke. Its mortality rate is high, and most survivors experience significant disability. Objective: To assess primary patient risk factors associated with mortality and neurologic disability 3 months after ICH in a large, racially and ethnically balanced cohort. Design, Setting, and Participants: This cohort study included participants from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, which prospectively recruited 1000 non-Hispanic White, 1000 non-Hispanic Black, and 1000 Hispanic patients with spontaneous ICH to study the epidemiological characteristics and genomics associated with ICH. Participants included those with uniform data collection and phenotype definitions, centralized neuroimaging review, and telephone follow-up at 3 months. Analyses were completed in November 2021. Exposures: Patient demographic and clinical characteristics as well as hospital event and imaging variables were examined, with characteristics meeting P <.20 considered candidates for a multivariate model. Elements included in the ICH score were specifically analyzed. Main Outcomes and Measures: Individual characteristics were screened for association with 3-month outcome of neurologic disability or mortality, as assessed by a modified Rankin Scale (mRS) score of 4 or greater vs 3 or less under a logistic regression model. A total of 25 characteristics were tested in the final model, which minimized the Akaike information criterion. Analyses were repeated removing individuals who had withdrawal of care. Results: A total of 2568 patients (mean [SD] age, 62.4 [14.7] years; 1069 [41.6%] women and 1499 [58.4%] men) had a 3-month outcome determination available, including death. The final logistic model had a significantly higher area under the receiver operating characteristics curve (C = 0.88) compared with ICH score alone (C = 0.76; P <.001). Among characteristics associated with neurologic disability and mortality were larger log ICH volume (OR, 2.74; 95% CI, 2.36-3.19; P <.001), older age (OR per 1-year increase, 1.04; 95% CI, 1.02-1.05; P <.001), pre-ICH mRS score (OR, 1.62; 95% CI, 1.41-1.87; P <.001), lobar location (OR, 0.22; 95% CI, 0.16-0.30; P <.001), and presence of infection (OR, 1.85; 95% CI, 1.42-2.41; P <.001). Conclusions and Relevance: The findings of this cohort study validate ICH score elements and suggest additional baseline and interim patient characteristics were associated with variation in 3-month outcome..