The Effect of Age on Characteristics and Mortality of Intracerebral Hemorrhage in the Oldest-Old

Abstract

Background: Incidence of acute intracerebral hemorrhage (ICH) increases with age, but there is a lack of information about ICH characteristics in the oldest-old (age ≥85 years). In particular, there is a need for information about hematoma volume, which is included in most clinical scales for prediction of mortality in ICH patients. Many of these scales also assume that, independent of ICH characteristics, the oldest-old have a higher mortality than younger elderly patients (age 65-74 years). However, supporting evidence from cohort studies is limited. We investigated ICH characteristics of oldest-old subjects compared to young (<65 years), young-old (65-74 years) and old-old (75-84 years) subjects. We also investigated whether age is an independent mortality predictor in elderly (age ≥65 years) subjects with acute ICH. Methods: We retrospectively collected clinical and neuroimaging data of 383 subjects (age 34-104 years) with acute supratentorial primary ICH who were admitted to an Italian Stroke Unit (SU) between October 2007 and December 2014. Measured ICH characteristics included hematoma location, volume and intraventricular extension of hemorrhage on admission CT scan; admission Glasgow Coma Scale ≤8 and hematoma expansion (HE) measured on follow-up CT-scans obtained after 24 h. General linear models and logistic models were used to investigate the association of age with ICH characteristics. These models were adjusted for pre-admission characteristics, hematoma location and time from symptom onset to admission CT scan. Limited to elderly subjects, Cox models were used to investigate the association of age with in-SU and 1-year mortality: the model for in-SU mortality adjusted for pre-admission and ICH admission characteristics and the model for 1-year mortality additionally adjusted for functional status and disposition at SU discharge. Results: Independent of pre-admission characteristics, hematoma location and time from symptom onset to admission CT-scan, oldest-old subjects had the highest admission hematoma volume (p < 0.01). Age was unrelated to all other ICH characteristics including HE. In elderly patients, multivariable adjusted risk of in-SU and 1-year mortality did not vary across age categories. Conclusions: Oldest-old subjects with acute supratentorial ICH have higher admission hematoma volume than young and young-old subjects but do not differ for other ICH characteristics. When taking into account confounding from ICH characteristics, risk of in-SU and 1-year mortality in elderly subjects with acute supratentorial ICH does not differ across age categories. Our findings question use of age as an independent criterion for stratification of mortality risk in elderly subjects with acute ICH.

Hematoma Expansion in Intracerebral Hemorrhage: An Update on Prediction and Treatment

“…Gender ( 40 ) and age ( 41 ) are also associated with HE, as men and older subjects (age ≥85 years) are more likely to present HE than women and younger subjects ( 40 , 41 ).…”

Race and in-hospital mortality after spontaneous intracerebral hemorrhage in the Stroke Belt: Secondary analysis of a case–control study

“…Within this sample, we failed to show that age differences significantly affected outcomes by race. Older age has been associated with ICH etiology [12] and lobar location [12,13], increased hematoma volume and intraventricular hemorrhage [13], as well as poor outcome [24]. However, it has also been shown that advanced age and cerebral atrophy may offer some protection against in-hospital mortality after ICH [25], perhaps due to a greater room for hematoma expansion.…”

“…Lastly, the influence of age, which carries a significant association with ICH etiology [12,13], further compounds these considerations regarding ICH risk factors and outcomes. For example, while recent studies indicated poorer outcomes for White patients after ICH, these disparities were specific for younger adults and from a national perspective [14].…”

The Effect of Aging and Small-Vessel Disease Burden on Hematoma Location in Patients with Acute Intracerebral Hemorrhage

“…Four patients were also excluded due to pure intraventricular hemorrhage. Finally, 444 patients (156 women [35%]; median age, 69 [IQR 59-79] years; NIHSS score, 9 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]; median time from symptom onset to admission, 2.60 [1.01-12.0] hours) were enrolled in the present study (see online suppl. Fig.…”