Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study

Rådholm, Karin; Arima, Hisatomi; Lindley, Richard I; Wang, J.; Tzourio, Christophe; Robinson, Thompson G.; Heeley, Emma; Anderson, C; Chalmers, John

doi:10.1093/ageing/afu198

Cited by 58 publications

(60 citation statements)

References 25 publications

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“…This is likely to reflect the fact that these are extensive ICH spanning from deep structures to the cortex. Finally, the analysis confirms well-recognized associations between older age, 11,12 higher neurologic severity, ICH volume, and poor outcomes. 1 …”

Section: Discussionsupporting

confidence: 76%

Intracerebral hemorrhage location and outcome among INTERACT2 participants

Delcourt¹,

Sato²,

Zhang³

et al. 2017

Neurology

104

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Objective:To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).Methods:Associations between ICH sites and poor outcomes (death [6] or major disability [3–5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models.Results:Of 2,066 patients included in the analyses, associations were identified between ICH sites and poor outcomes: involvement of posterior limb of internal capsule increased risks of death or major disability (odds ratio [OR] 2.10) and disability (OR 1.81); thalamic involvement increased risks of death or major disability (OR 2.24) and death (OR 1.97). Involvement of the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor EQ-5D utility score (≤0.7 [median]; OR 1.87, 2.14, and 2.81, respectively). Posterior limb of internal capsule involvement was strongly associated with low scores across all health-related quality of life domains. ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability, major disability, and poor EQ-5D utility score (OR 1.72, 2.26, and 1.71, respectively).Conclusion:Poor clinical outcomes are related to ICH affecting the posterior limb of internal capsule, thalamus, and infratentorial sites. The highest association with death or major disability and poor EQ-5D utility score was seen in ICH encompassing the thalamus and posterior limb of internal capsule.ClinicalTrials.gov registration:NCT00716079.

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Section: Discussionsupporting

confidence: 76%

Intracerebral hemorrhage location and outcome among INTERACT2 participants

Delcourt¹,

Sato²,

Zhang³

et al. 2017

Neurology

104

View full text Add to dashboard Cite

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“…Worse stroke outcomes for African Americans and older patients have also been reported in the literature. 39 Though a number of factors have been described that contribute to disparate cerebrovascular disease burden in terms of incidence, prevalence, and outcomes in African Americans, 40,41 differential post-stroke peripheral immune response mediated via the spleen may also represent one of the contributory mechanisms for worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Acute splenic responses in patients with ischemic stroke and intracerebral hemorrhage

Vahidy

Parsha

Rahbar

et al. 2015

J Cereb Blood Flow Metab

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Animal models provide evidence of spleen mediated post-stroke activation of the peripheral immune system. Translation of these findings to stroke patients requires estimation of pre-stroke spleen volume along with quantification of its dayto-day variation. We enrolled a cohort of 158 healthy volunteers and measured their spleen volume over the course of five consecutive days. We also enrolled a concurrent cohort of 158 stroke patients, measured initial spleen volume within 24 h of stroke symptom onset followed by daily assessments. Blood samples for cytokine analysis were collected from a subset of patients. Using data from healthy volunteers, we fit longitudinal quantile regression models to construct gender and body surface area based normograms of spleen volume. We quantified day-to-day variation and defined splenic contraction. Based on our criteria, approximately 40% of stroke patients experienced substantial post-stroke reduction in splenic volume. African Americans, older patients, and patients with past history of stroke have significantly higher odds of post-stroke splenic contraction. All measured cytokine levels were elevated in patients with splenic contraction, with significant differences for interferon gamma, interleukin 6, 10, 12, and 13. Our work provides reference standards for further work, validation of pre-clinical findings, and characterization of patients with post-stroke splenic contraction.

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“…The severity of neurologic deficits at admission was the main predictor of functional independence and mortality. Methamphetamine use and demographic features including age were not independently associated with outcomes as they had been in previous studies 17,29,30 . Of note, our findings are significantly different from what was previously reported.…”

Section: Discussionmentioning

confidence: 48%

“…The majority of Meth-ICH was located in the basal ganglia/thalamus, suggesting deep white matter small-vessel injuries from direct toxicity of methamphetamine or increased sympathetic system activation 15,17,27 . The proportion of lobar hemorrhage was significantly higher in Non-Meth-ICH (38.0% vs 16.4%), likely due to older age and history of hypertension, ischemic stroke, or cerebral amyloid angiopathy [28][29][30] .…”

Section: Discussionmentioning

confidence: 90%

Clinical characteristics and outcomes of methamphetamine-associated versus non-methamphetamine intracerebral hemorrhage

Zhu

Osman

Stradling

et al. 2020

Sci Rep

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Methamphetamine use has emerged as a risk factor for intracerebral hemorrhage (ICH). We aim to investigate the clinical characteristics and outcomes of methamphetamine-associated ICH (Meth-ICH) versus Non-Meth-ICH. Patients with ICH between January 2011 and December 2017 were studied. Meth-ICH and Non-Meth-ICH were defined by history of abuse and urine drug screen (UDS). The clinical features of the 2 groups were explored. Among the 677 consecutive patients, 61 (9.0%) were identified as Meth-ICH and 350 as Non-Meth ICH. Meth-ICH was more common in Hispanics (14.6%) and Whites (10.1%) as compared to Asians (1.2%). Patients with Meth-ICH were more often younger (51.2 vs. 62.2 years, p < 0.001), male (77.0% vs. 61.4.0%, p < 0.05), and smokers (44.3% vs. 13.4%, p < 0.001). Non-Meth-ICH was more likely to have history of hypertension (72.61% v. 59%, p < 0.05) or antithrombotic use (10.9% vs. 1.6%, p < 0.05). There was no significant difference in clinical severity, hospital length of stay (LOS), rate of functional independence (29.5% vs. 25.7%, p = 0.534), or mortality (18.0% vs. 24.6%, p = 0.267) between the 2 groups. Methamphetamine use was not an independent predictor of poor outcome. Despite difference in demographics, Meth-ICH is similar to Non-Meth ICH in hospital course and outcome. MethodsThis is a retrospective observational study. It was approved by the University of California Irvine Institutional Review Board (IRB) and the Ethics Committee. Informed consents were waived as part of the IRB approval. All methods in the study were performed in accordance with the relevant guidelines and regulations.Consecutive patients with spontaneous ICH at the University of California Irvine Comprehensive Stroke Center between January 1, 2011 and December 31, 2017 were identified by searching electronic medical records and the prospectively maintained American Heart Association (AHA)-Get With The Guidelines (GWTG)-Stroke Registry. ICH from cerebral aneurysm, arteriovenous malformation, brain tumors, coagulopathy, or trauma were excluded. Patients with Meth-ICH were identified by recorded history of methamphetamine use or a positive urine drug screen (UDS) at the time of admission. The UDS was performed using EMIT II Plus Amphetamines assay (1,000 ng/mL cutoff) with a sensitivity and specificity of 94.3% and 93.3%, respectively 21 . Those with a positive UDS while taking trazodone, Adderall, bupropion, or labetalol within 2 weeks of admission were excluded due to potential false-positive result 22 . Patients with no history of methamphetamine use and a negative UDS were included in Non-Meth-ICH group. Patients who denied history of drug abuse but had no UDS were excluded from the comparison analysis. All ICH patients were initially managed in the dedicated Neuroscience ICU with standard ICH order-set and clinical pathway by board-certified neurointensivists.The following information was abstracted from chart review and the AHA GWTG-Stroke Registry: age, gender, race, past medical history, the highest blood pressure (BP) lev...

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Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study

Abstract: http://www.clinicaltrials.gov (NCT00716079).

Cited by 58 publications

References 25 publications

Intracerebral hemorrhage location and outcome among INTERACT2 participants

Intracerebral hemorrhage location and outcome among INTERACT2 participants

Acute splenic responses in patients with ischemic stroke and intracerebral hemorrhage

Clinical characteristics and outcomes of methamphetamine-associated versus non-methamphetamine intracerebral hemorrhage

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