Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage.

Abstract

BACKGROUND AND PURPOSE:

Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce.

METHODS:

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).

RESULTS:

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).

CONCLUSIONS:

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.

• Authors: Martina B Goeldlin, Achim Mueller, Bernhard M Siepen, Madlaine Mueller, Davide Strambo, Patrik Michel, Michael Schaerer, Carlo W Cereda, Giovanni Bianco, Florian Lindheimer, Christian Berger, Friedrich Medlin, Roland Backhaus, Nils Peters, Susanne Renaud, Loraine Fisch, Julien Niederhaeuser, Emmanuel Carrera, Elisabeth Dirren, Christophe Bonvin, Rolf Sturzenegger, Timo Kahles, Krassen Nedeltchev, Georg Kaegi, Jochen Vehoff, Biljana Rodic, Manuel Bolognese, Ludwig Schelosky, Stephan Salmen, Marie-Luise Mono, Alexandros A Polymeris, Stefan T Engelter, Philippe Lyrer, Susanne Wegener, Andreas R Luft, Werner Z'Graggen, David Bervini, Bastian Volbers, Tomas Dobrocky, Johannes Kaesmacher, Pasquale Mordasini, Thomas R Meinel, Marcel Arnold, Javier Fandino, Leo H Bonati, Urs Fischer, David J Seiffge, SSR Investigators
• Journal: Journal of stroke (J Stroke) Vol. 24 Issue 2 Pg. 266-277 (May 2022) ISSN: 2287-6391 [Print] Korea (South)
• PMID: 35677981 (Publication Type: Journal Article)