Differences in outcome and predictors between ischemic and intracerebral hemorrhage: the South London Stroke Register

Abstract

Background and purpose: Few population-based studies describing functional outcome between ischemic stroke and intracerebral hemorrhage (ICH) in the short- and long-term are available. Knowledge of the natural history and factors associated with poor outcome is important in providing prognostic information and resource allocation.

Methods: Data were collected within the population-based South London Stroke Register between 1995 and 2011. Baseline data were collection of sociodemographic factors, case mix, risk factors before stroke, and acute stroke processes, with outcomes at 7 days, 3 months, 1 year, 5 years, and 10 years after stroke. Logistic regression was used to determine factors associated with poor outcome (dead and dependency: Barthel index<15).

Results: Age and incontinence were associated with poor outcome at 3 months, 1 year, 5 years, and 10 years in ICH, whereas age, incontinence, failed swallow, atrial fibrillation, and diabetes mellitus were associated with poor outcome in ischemic stroke. ICH was more likely to have poorer outcomes at 3 months (odds ratio, 2.2; 95% confidence interval [CI], 1.8-2.8) and 1 year (odds ratio, 2.1; 95% CI, 1.7-2.6) but not at 5 years (odds ratio, 1.1; 95% CI, 0.8-1.4) or 10 years (odd ratio, 0.8; 95% CI, 0.57-1.22); however, the improvement of functional outcome from day 7 to 3 months was significantly greater for ICH (regression coefficient: 1.8; 95% CI, 1.1-2.6; P<0.0001).

Conclusions: ICH has poorer outcomes up to 5 years after stroke. The improvement of functional outcome up to 3 months was significantly greater with ICH. Identification of factors associated with poor outcome may be used for clinical predictions.

Keywords: infarction; intracerbral hemorrhage; patient outcome; recovery of function.