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Observational Study
. 2020 Jul;27(7):1257-1263.
doi: 10.1111/ene.14238. Epub 2020 Apr 28.

Baseline factors associated with early and late death in intracerebral haemorrhage survivors

G Banerjee  1 , G Ambler  2 , D Wilson  1   3 , I C Hostettler  1 , C Shakeshaft  1 , S Lunawat  1 , H Cohen  4 , T Yousry  5 , R Al-Shahi Salman  6 , G Y H Lip  7   8 , H Houlden  9 , K W Muir  10 , M M Brown  1 , H R Jäger  5 , D J Werring  1 ; CROMIS-2 collaborators
Collaborators, Affiliations
Observational Study

Baseline factors associated with early and late death in intracerebral haemorrhage survivors

G Banerjee et al. Eur J Neurol. 2020 Jul.

Abstract

Background and purpose: The aim of this study was to determine whether early and late death are associated with different baseline factors in intracerebral haemorrhage (ICH) survivors.

Methods: This was a secondary analysis of the multicentre prospective observational CROMIS-2 ICH study. Death was defined as 'early' if occurring within 6 months of study entry and 'late' if occurring after this time point.

Results: In our cohort (n = 1094), there were 306 deaths (per 100 patient-years: absolute event rate, 11.7; 95% confidence intervals, 10.5-13.1); 156 were 'early' and 150 'late'. In multivariable analyses, early death was independently associated with age [per year increase; hazard ratio (HR), 1.05, P = 0.003], history of hypertension (HR, 1.89, P = 0.038), pre-event modified Rankin scale score (per point increase; HR, 1.41, P < 0.0001), admission National Institutes of Health Stroke Scale score (per point increase; HR, 1.11, P < 0.0001) and haemorrhage volume >60 mL (HR, 4.08, P < 0.0001). Late death showed independent associations with age (per year increase; HR, 1.04, P = 0.003), pre-event modified Rankin scale score (per point increase; HR, 1.42, P = 0.001), prior anticoagulant use (HR, 2.13, P = 0.028) and the presence of intraventricular extension (HR, 1.73, P = 0.033) in multivariable analyses. In further analyses where time was treated as continuous (rather than dichotomized), the HR of previous cerebral ischaemic events increased with time, whereas HRs for Glasgow Coma Scale score, National Institutes of Health Stroke Scale score and ICH volume decreased over time.

Conclusions: We provide new evidence that not all baseline factors associated with early mortality after ICH are associated with mortality after 6 months and that the effects of baseline variables change over time. Our findings could help design better prognostic scores for later death after ICH.

Keywords: intracerebral haemorrhage; mortality; prognosis.

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Conflict of interest statement

H.C. reports grants and other support from Bayer Healthcare and UCB outside the submitted work. T.Y. reports personal fees and other support from GlaxoSmithKline, Biogen Idec, Novartis, ESOR, Merck, Hikma and Parexel outside the submitted work. G.Y.H.L. reports consultancy and speaker fees from Bayer, Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi‐Sankyo outside the submitted work; no fees are directly received personally. K.W.M. reports personal fees from Bayer, personal fees and non‐financial support from Boehringer Ingelheim and personal fees from Daiichi‐Sankyo outside the submitted work. D.J.W. reports personal fees from Bayer, Alnylam and Portola outside the submitted work. The remaining authors declare no financial or other conflicts of interest.

Figures

Figure 1
Figure 1
Unadjusted cumulative mortality curve.
See this image and copyright information in PMC

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