Risk Factors Associated With Mortality and Neurologic Disability After Intracerebral Hemorrhage in a Racially and Ethnically Diverse Cohort

Woo, Daniel; Comeau, Mary E.; Venema, Simone Uniken; Anderson, Christopher; Flaherty, Matthew L.; Testai, Fernando D.; Kittner, Steven J.; Frankel, Michael; James, Michael L.; Sung, Gene; Elkind, Mitchell S.V.; Worrall, Bradford B.; Kidwell, Chelsea S.; Gonzales, Nicole R.; Koch, Sebastian; Hall, Christiana E.; Birnbaum, Lee; Mayson, Douglas; Coull, Bruce M.; Malkoff, Marc; Sheth, Kevin N; McCauley, Jacob L.; Osborne, Jennifer; Morgan, Misty; Gilkerson, Lee; Behymer, Tyler P; Coleman, Elisheva; Rosand, Jonathan; Sekar, Padmini; Moomaw, Charles J.; Langefeld, Carl D.

doi:10.1001/jamanetworkopen.2022.1103

Cited by 37 publications

(45 citation statements)

References 29 publications

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“…In this regard, preceding anticoagulation therapy remains a consistent factor associated with HE and poor ICH outcomes [15–18]. Thus, conventional coagulation assays (CCAs): platelet count and plasma-based prothrombin time/international normalized ratio (PT/INR) and partial thromboplastin time (PTT) are used to diagnose underlying coagulopathies so abnormalities related to anticoagulants may be corrected quickly.…”

Section: Hematoma Expansionmentioning

confidence: 99%

Transfusion medicine approaches for spontaneous intracerebral hemorrhage patients

Stone¹,

Poyraz

Roh

2023

Current Opinion in Critical Care

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Purpose of reviewSpontaneous intracerebral hemorrhage (ICH) is the deadliest stroke subtype. Acute treatments necessitate rapid hemorrhage control to minimize secondary brain injury. Here, we discuss the overlap of transfusion medicine and acute ICH care relating to diagnostic testing and therapies relevant for coagulopathy reversal and secondary brain injury prevention. Recent findingsHematoma expansion (HE) is the largest contributor to poor outcomes after ICH. Conventional coagulation assays to diagnose coagulopathy after ICH does not predict HE. Given the testing limitations, empiric pragmatic hemorrhage control therapies have been trialed but have not improved ICH outcomes, with some therapies even causing harm. It is still unknown whether faster administration of these therapies will improve outcomes. Alternative coagulation tests (e.g., viscoelastic hemostatic assays, amongst others) may identify coagulopathies relevant for HE, currently not diagnosed using conventional assays. This provides opportunities for rapid, targeted therapies. In parallel, ongoing work is investigating alternative treatments using transfusion-based or transfusion-sparing pharmacotherapies that can be implemented in hemorrhage control strategies after ICH.

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Section: Hematoma Expansionmentioning

confidence: 99%

Transfusion medicine approaches for spontaneous intracerebral hemorrhage patients

Stone¹,

Poyraz

Roh

2023

Current Opinion in Critical Care

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“…Despite increasingly standardized care for acute clinical management of intracerebral hemorrhage (ICH), disparate outcomes after ICH have been described [10][11][12][13][14][15][16] . Given prior literature suggesting a role for educational attainment impacting risk and recovery for stroke, we hypothesize that in addition to traditional clinical risk factors, such as hypertension, education will be associated with ICH severity and recovery.…”

Section: Introductionmentioning

confidence: 99%

Educational attainment in hemorrhagic stroke severity and functional outcome

Yechoor

Rist

Ganbold

et al. 2023

Preprint

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Introduction: While stroke education is a hallmark of clinical care in primary stroke centers, the educational attainment of patients is rarely considered. The objective of this study is to determine whether educational attainment, in addition to traditional risk factors, is associated with intracerebral hemorrhage (ICH) severity and functional outcomes.<break><break>Methods: Subjects were enrolled in a prospectively ascertained cohort of patients with primary ICH from 1994 until 2020 at the Massachusetts General Hospital Neurosciences Intensive Care Unit. Data on social determinants of health (SDOH), past medical history for ICH risk factors, and ICH severity were obtained on admission. The primary outcome was stroke severity, calculated using the ICH score. The secondary outcome was 12-month modified Rankin Score (mRS). <break><break>Results: Of 2,539 patients eligible for analyses, 1,744 (69%) presented with mild ICH (ICH Score < 3) and 795 (31%) presented with severe ICH (ICH score 3). In a multivariable logistic regression analysis controlling for age, income, and a pre-stroke diagnosis of coronary artery disease, only educational attainment was associated with stroke severity, with patients with high school-only education more likely to present with a severe ICH compared to college diplomates (odds ratio 2.37, 95% CI 1.77, 3.19). Additionally, those with high school-only education were less likely to recover to a good functional outcome (mRS<4) after ICH when compared to college diplomates (odds ratio 0.43, 95% CI 0.19, 0.93) when controlling for stroke severity, and pre-stroke diagnoses of hypertension and dementia. <break><break>Discussion: Pre-stroke educational attainment is an independent predictor of ICH severity and subsequent functional outcomes at 12-month post-stroke. Given the association with recovery, tailoring inpatient stroke education to level of educational attainment may serve to reduce the disparity in outcomes after hemorrhagic stroke. Educational attainment may act as both a social and a biological determinant, and could represent a modifiable risk factor for ICH survivors.

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“…Although well-defined management approaches exist [10], prognosis has been shown to be poor in patients demonstrating hematoma regrowth or rebleeding, which occur at some degree in about three-quarters of patients within the first few hours of the index event [11]. Prevention of further complications in spontaneous ICH, through intensive medical treatment and/or surgical evacuation, is critical to reduce morbidity and mortality [12]. Factors associated with mortality and poor outcome include the aforementioned risk factors of ICH development, early termination of aggressive therapy, localization, hematoma shape and size, imaging findings, and several laboratory markers, including C-reactive protein (CRP), glucose, and cholesterol fractions [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…Prevention of further complications in spontaneous ICH, through intensive medical treatment and/or surgical evacuation, is critical to reduce morbidity and mortality [12]. Factors associated with mortality and poor outcome include the aforementioned risk factors of ICH development, early termination of aggressive therapy, localization, hematoma shape and size, imaging findings, and several laboratory markers, including C-reactive protein (CRP), glucose, and cholesterol fractions [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Evaluation of Hematological and Clinical Factors Associated with 30-Day Mortality in 170 Patients Diagnosed with Intracerebral Hematoma in a Single Center in Turkey

Gülensoy

2022

Med Sci Monit

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Background:This retrospective study from a single center in Turkey aimed to evaluate hematological and clinical factors related with 30-day mortality in patients diagnosed with intracerebral hematoma (ICH) between 2013 and 2021. Material/Methods:All 170 consecutive patients (>18 years) admitted to the Intensive Care Unit (ICU) with spontaneous ICH were analyzed. Cranial computed tomography was performed in all patients. Venous blood samples were routinely obtained upon admission. Demographic characteristics, blood test results, imaging data, and survival data were retrieved from the institutional digital database. The primary goal of this study was to investigate the role of presenting demographic and clinical characteristics and blood tests in predicting 30-day mortality in patients with spontaneous ICH. Results:Receiver operating characteristic curve analysis showed that the Glasgow coma scale (GCS) score (£9), hematoma volume (>13.4 cm 3 ), hemoglobin (£13.1 g/dL), international normalized ratio (>1.25), C-reactive protein (CRP) (>7.5 mg/L), and third-day neutrophil-to-lymphocyte ratio (>17.8) could be used to predict 30-day mortality. Patients with low GCS scores (£9) had a 14.432-fold higher risk of death than other patients (OR: 14.432, 95% CI: 6.421-32.441, P<0.001). Patients with high CRP levels (>7.5) had a 3.323-fold higher risk of death than other patients (OR: 3.323, 95% CI: 1.491-7.405, P=0.003). Conclusions:Tailoring scoring systems to include CRP may be beneficial for predicting spontaneous ICH prognosis. However, further studies assessing CRP and other inflammatory markers are necessary to assess whether inflammatory activity could be associated with worse outcomes in patients with ICH.

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Risk Factors Associated With Mortality and Neurologic Disability After Intracerebral Hemorrhage in a Racially and Ethnically Diverse Cohort

Cited by 37 publications

References 29 publications

Transfusion medicine approaches for spontaneous intracerebral hemorrhage patients

Transfusion medicine approaches for spontaneous intracerebral hemorrhage patients

Educational attainment in hemorrhagic stroke severity and functional outcome

Retrospective Evaluation of Hematological and Clinical Factors Associated with 30-Day Mortality in 170 Patients Diagnosed with Intracerebral Hematoma in a Single Center in Turkey

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