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. 2021 Jul 1;4(7):e2115859.
doi: 10.1001/jamanetworkopen.2021.15859.

Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury

David Haupenthal  1 , Joji B Kuramatsu  1 , Bastian Volbers  1 , Jochen A Sembill  1 , Anne Mrochen  1 , Stefanie Balk  1 , Philip Hoelter  2 , Hannes Lücking  2 , Tobias Engelhorn  2 , Arnd Dörfler  2 , Stefan Schwab  1 , Hagen B Huttner  1 , Maximilian I Sprügel  1
Affiliations

Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury

David Haupenthal et al. JAMA Netw Open. .

Abstract

Importance: Intracerebral hemorrhage (ICH) contributes significantly to the global burden of disease.

Objective: To examine the association of ICH and secondary injury with disability-adjusted life-years (DALYs) for the individual patient.

Design, setting, and participants: This cohort study was conducted using data from the Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage study. Consecutive patients admitted to a single tertiary care center from January 1, 2006, to December 31, 2015, were included. The sample comprised patients with oral anticoagulation-associated ICH (OAC-ICH) or primary spontaneous ICH (non-OAC-ICH). Statistical analysis was conducted from October 1 to December 31, 2020.

Exposures: ICH occurrence and secondary injury.

Main outcomes and measures: DALYs, years of life lost (YLL), and years lived with disability (YLD) were analyzed by hematoma location, ICH volume, and secondary injury (ie, hematoma expansion [HE], intraventricular hemorrhage [IVH], and perihemorrhagic edema [PHE]).

Results: Among 1322 patients with ICH, 615 (46.5%) were women and the mean (SD) age at hospital admission was 71 (13) years; ICH was associated with a mean (SD) of 9.46 (8.08) DALYs, 5.72 (8.29) YLL, and 3.74 (5.95) YLD. There were statistically significant differences in mean (SD) DALYs by extent of hematoma volume (< 10 mL ICH: 7.05 [6.79] DALYs; 10-30 mL ICH: 9.91 [8.35] DALYs; >30 mL ICH: 12.42 [8.47] DALYs; P < .001) and ICH location (deep location: 10.60 [8.35] DALYs; lobar location: 8.18 [7.63] DALYs; cerebellum: 8.14 [6.80] DALYs; brainstem: 12.63 [9.21] DALYs; P < .001). Regarding population-level disease burden of secondary injuries after ICH, there was a statistically significant difference in mean (SD) by injury type, with 0.94 (3.19) DALYs for HE, 2.45 (4.16) DALYs for IVH, and 1.96 (2.66) DALYs for PHE (P < .001) among the entire ICH cohort. Regarding individual-level exposure to secondary injuries after ICH, there were a mean (SD) 7.14 (6.62) DALYs for HE, 4.58 (4.75) DALYs for IVH, and 3.35 (3.28) DALYs for PHE among patients with ICH affected by secondary injuries.

Conclusions and relevance: These findings suggest that there is a high burden of disability associated with ICH and secondary injuries, and the findings may guide public health strategies. The study findings further suggest that IVH and PHE may be relevant for the overall outcome of patients with ICH, that DALYs may represent a viable outcome parameter for studies to evaluate treatment outcomes in ICH research, and that IVH and PHE may represent potential treatment targets.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kuramatsu reported receiving grants from Medtronic and personal fees from Abbott, Bayer, Pfizer, and Biogen outside the submitted work. Dr. Volbers reported receiving personal fees from Pfizer, Bristol-Myers Squibb, Bayer, Ipsen, and CSL Behring and grants from Inselspital outside the submitted work. Dr Huttner reported receiving personal fees from Bayer, Boehringer Ingelheim, Portola Pharmaceuticals, Novartis, and Daiichi Sankyo and grants from Medtronic outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Disability-Adjusted Life-Years (DALYs) After Intracerebral Hemorrhage (ICH)
Concept and calculation of years of life lost (YLL), years lived with disability (YLD), and DALYs are illustrated for patients with ICH. DALYs are defined as the sum of YLD and YLL owing to premature mortality as a result of the ICH event.
See this image and copyright information in PMC

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