Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

Abstract

BackgroundIntracerebral hemorrhage (ICH) carries high risk for short‐term mortality. We sought to identify race‐specific predictors of mortality in ICH patients.Methods and ResultsWe used 2 databases, the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample (NIS). We included 226 patients with the primary diagnosis of spontaneous ICH from our stroke database between 2010 and 2013; in the NIS, 42 077 patients met inclusion criteria. Logistic regression was used to assess differences in predictors of mortality in blacks compared to whites. In our clinical stroke database, Glasgow Coma Scale (GCS; P=0.016), ICH volume (P=0.013), intraventricular haemorrhage (IVH; P=0.023), and diabetes mellitus (P=0.037) were predictors of mortality in blacks, whereas GCS (P=0.007), ICH volume (P=0.005), age (P=0.002), chronic kidney disease (P=0.003), and smoking (P=0.010) predicted mortality in whites. Among patients with IVH, blacks had over 7 times higher odds of mortality compared to whites (odds ratio [OR], 7.27; P value for interaction, 0.017) and were more likely to present with hydrocephalus (OR, 2.76; P=0.026). In the NIS, black ICH patients had higher rates of external ventricular drain (EVD) placement compared to whites (9.7% vs 5.0%; P<0.001) and were more likely to develop hydrocephalus (OR, 1.32; 95% CI, 1.20–1.46). Comparison of a race‐specific ICH score to the original ICH score showed that the various ICH score components have differential relevance for ICH score performance by race.Conclusions IVH and age differentially predict mortality among blacks and whites. Blacks have higher rates of obstructive hydrocephalus and more frequently require EVD placement compared to their white counterparts.

Tobacco Use: A Major Risk Factor of Intracerebral Hemorrhage

“…Smoking is considered as an important predictor of substantial hematoma expansion (SHE), short-and long-term mortality, and poor outcome in sICH patients. [86][87][88] As mentioned previously, hematoma expansion occurs in the majority of sICH patients following ictus. The risk of post-ictus hematoma expansion is higher in tobacco-using sICH patients.…”

“…Besides increasing the risk of sICH, earlier clinical studies also established that tobacco use also worsens outcomes following sICH ( Figure 1 ). Smoking is considered as an important predictor of substantial hematoma expansion (SHE), short- and long-term mortality, and poor outcome in sICH patients [ 86 - 88 ]. As mentioned previously, hematoma expansion occurs in the majority of sICH patients following ictus.…”

“…As cigarette smoking increases the risk of hematoma expansion, it also increases the risk of poorer outcomes and death from sICH ( Figure 1 ). Based on the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample database, Faigle et al [ 86 ] observed that black (OR, 3.31; P =0.074) and white (OR, 7.42; P =0.010) smoker sICH patients had a higher risk of in-hospital mortality. Another study by Saloheimo et al [ 87 ] evaluated risk factors for death in sICH patients (n=140) that survived the acute phase (3 months) and compared their long-term prognosis with the control population (n=206).…”

Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage

“…The third is the uniform diagnosis of ICH and the availability of variables including components of the ICH score and FUNC score to control for clinical severity and comorbid conditions that impact CMO decisions. 28–30 Furthermore, demographic information including education level and insurance status were available to evaluate other influences on CMO decisions.…”

Nicotinic Acetylcholine Receptor Signaling in Neuroprotection

“…Race/population-specific influences of smoking on ICH incidence have also been reported. A study by Faigle et al (2016) showed that smoking was one of the predictors of mortality in white populations, but not black populations, of ICH patients. In addition, meta-analyses of the risk factors for ICH and ischemic stroke suggest that smoking is a risk factor more frequent in ischemic stroke in white population but not in Chinese population (Tsai et al 2016).…”