Three-Year Survival and Stroke Recurrence Rates in Patients With Primary Intracerebral Hemorrhage

Background and Purpose— There are few studies on the prognosis after primary intracerebral hemorrhages, and they reported big differences in mortality rates. Our aim was to evaluate mortality and stroke recurrence rates in relation to hemorrhage characteristics, demographic and clinical factors, in a large unselected patient cohort. Methods— We analyzed consecutive cases of first-ever primary intracerebral hemorrhages from 1993 to 2000 in a prospective stroke register covering the Malmö region, Sweden (population approximately 250 000). Mortality rates during 28 days and 3 years of follow-up and recurrence rates were analyzed. Results— A total of 474 cases were identified (46% women). In patients <75 years of age, 20% of the women and 23% of the men died within 28 days (P=0.38). The corresponding figures in patients ≥75 years were 26% and 41%, respectively (P=0.02). Male sex was an independent risk factor both for 28-day (OR, 1.5; 95% CI, 1.008 to 2.2) and 3-year mortality (OR, 1.7; 95% CI, 1.3 to 2.3). Other independent predictors of death were high age, central and brain stem hemorrhage location, intraventricular hemorrhage, increased volume, and decreased consciousness level. The recurrence rate was 5.1 per 100 person-years, 2.3 per 100 person-years for intracerebral hemorrhage and 2.8 per 100 person-years for cerebral infarction. Only age >65 years was significantly related to recurrent stroke. Conclusion— Women had better survival than men after primary intracerebral hemorrhages. The difference is largely explained by a higher 28-day mortality in male patients >75 years. However, the underlying reasons are yet to be explored.

[1]  C. Anderson,et al.  Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2010, Stroke.

[2]  S. Juvela,et al.  Hypertension and diabetes as predictors of early death after spontaneous intracerebral hemorrhage. , 2009, Journal of neurosurgery.

[3]  S. Sacco,et al.  Incidence and 10-Year Survival of Intracerebral Hemorrhage in a Population-Based Registry , 2009, Stroke.

[4]  K. Nagata,et al.  Antithrombotic Therapy Influences Location, Enlargement, and Mortality from Intracerebral Hemorrhage , 2008, Cerebrovascular Diseases.

[5]  James A. Koziol,et al.  Predictors of Intracerebral Hemorrhage Severity and Its Outcome in Japanese Stroke Patients , 2008, Cerebrovascular Diseases.

[6]  T. Olsen,et al.  The Female Stroke Survival Advantage: Relation to Age , 2008, Neuroepidemiology.

[7]  S. Kasner,et al.  Hematoma Growth in Oral Anticoagulant Related Intracerebral Hemorrhage , 2008, Stroke.

[8]  M. Azarpazhooh,et al.  Patterns of Stroke Recurrence According to Subtype of First Stroke Event: The North East Melbourne Stroke Incidence Study (NEMESIS) , 2008, International journal of stroke : official journal of the International Stroke Society.

[9]  C. Anderson,et al.  Trends in Incidence and Outcome of Stroke in Perth, Western Australia During 1989 to 2001: The Perth Community Stroke Study , 2008, Stroke.

[10]  T. Olsen,et al.  Sex-Related Time-Dependent Variations in Post-Stroke Survival – Evidence of a Female Stroke Survival Advantage , 2007, Neuroepidemiology.

[11]  G. Berglund,et al.  Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral Hemorrhage: Hypertensive Hemorrhage: Debated Nomenclature Is Still Relevant , 2007, Stroke.

[12]  J. M. Gordon.  HOSPITAL VOLUME AND STROKE OUTCOME: DOES IT MATTER? , 2007, Neurology.

[13]  P. Rothwell,et al.  Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study , 2007, The Lancet Neurology.

[14]  L. Lisabeth,et al.  Early care limitations independently predict mortality after intracerebral hemorrhage , 2007, Neurology.

[15]  Michael D Hill,et al.  Determinants of Intracerebral Hemorrhage Growth: An Exploratory Analysis , 2007, Stroke.

[16]  T. Wilkinson,et al.  The risk of recurrent stroke after intracerebral haemorrhage , 2007, Journal of Neurology, Neurosurgery & Psychiatry.

[17]  A. Mcguire,et al.  Long-Term Mortality, Morbidity and Hospital Care following Intracerebral Hemorrhage: An 11-Year Cohort Study , 2006, Cerebrovascular Diseases.

[18]  T. Olsen,et al.  Cardiovascular Risk Factors and 5-Year Mortality in the Copenhagen Stroke Study , 2006, Cerebrovascular Diseases.

[19]  S. Avikainen,et al.  Long term survival after primary intracerebral haemorrhage: a retrospective population based study , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[20]  S. Avikainen,et al.  Admission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[21]  S. Greenberg,et al.  Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage , 2004, Neurology.

[22]  Z. Nagy,et al.  Regional Differences in Incidence Rates, Outcome Predictors and Survival of Stroke , 2004, Neuroepidemiology.

[23]  A. Dávalos,et al.  Early neurologic deterioration in intracerebral hemorrhage , 2004, Neurology.

[24]  N. Ohbayashi,et al.  Primary Intracerebral Hemorrhage in Izumo City, Japan: Incidence Rates and Outcome in Relation to the Site of Hemorrhage , 2003, Neurosurgery.

[25]  G. Engström,et al.  Risk of haemorrhagic stroke in patients with oral anticoagulation compared with the general population , 2003, Journal of internal medicine.

[26]  B. Norrving,et al.  Sex Differences in Management and Outcome After Stroke: A Swedish National Perspective , 2003, Stroke.

[27]  G. Engström,et al.  Increasing Stroke Incidence and Decreasing Case Fatality, 1989–1998: A Study From the Stroke Register in Malmö, Sweden , 2003, Stroke.

[28]  A. Lindgren,et al.  Prediction of death in patients with primary intracerebral hemorrhage: a prospective study of a defined population. , 2002, Journal of neurosurgery.

[29]  B. Norrving,et al.  Stroke in Lund-Orup, Sweden: Improved Long-Term Survival Among Elderly Stroke Patients , 2002, Stroke.

[30]  K. Greenlund,et al.  Racial/ethnic disparities in mortality by stroke subtype in the United States, 1995-1998. , 2001, American journal of epidemiology.

[31]  S. Eriksson,et al.  Survival and Recurrent Strokes in Patients with Different Subtypes of Stroke: A Fourteen-Year Follow-Up Study , 2001, Cerebrovascular Diseases.

[32]  O. Benavente,et al.  Recurrent brain hemorrhage is more frequent than ischemic stroke after intracranial hemorrhage , 2001, Neurology.

[33]  P. Austin,et al.  Sex differences and similarities in the management and outcome of stroke patients. , 2000, Stroke.

[34]  L. Rumbach,et al.  Primary Intracerebral Hemorrhages in the Besançon Stroke Registry , 2000, European Neurology.

[35]  E. Barrett-Connor.  Sex differences in coronary heart disease. Why are women so superior? The 1995 Ancel Keys Lecture. , 1997, Circulation.

[36]  T Brott,et al.  The ABCs of measuring intracerebral hemorrhage volumes. , 1996, Stroke.

[37]  W M O'Fallon,et al.  Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. , 1996, Stroke.

[38]  A. Alexandrov,et al.  Do-not-resuscitate orders in acute stroke , 1995, Neurology.

[39]  G. Berglund,et al.  Stroke Registry in Malmö, Sweden , 1992, Stroke.

[40]  J Bamford,et al.  The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[41]  B. Jennett,et al.  Assessment of coma and impaired consciousness. A practical scale. , 1974, Lancet.

[42]  S. Mayer,et al.  Treatment of warfarin-associated intracerebral hemorrhage: literature review and expert opinion. , 2007, Mayo Clinic proceedings.

[43]  P. Austin,et al.  Rate of stroke recurrence in patients with primary intracerebral hemorrhage. , 2000, Stroke.

[44]  The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. , 1988, Journal of clinical epidemiology.

[45]  Principal Investigators,et al.  The World Health Organization MONICA project (monitoring trends and determinants in cardiovascular disease): a major international collabaration , 1988 .

[46]  M. Kornitzer,et al.  The World Health Organization MONICA Project (Monitoring trends and determinants in cardiovascular disease): A major international Collaboration , 1988 .