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Zhang L, Li J, Yin K, Jiang Z, Li T, Hu R, Yu Z, Feng H, Chen Y. Computed tomography angiography-based analysis of high-risk intracerebral haemorrhage patients by employing a mathematical model. BMC Bioinformatics 2019; 20:193. [PMID: 31074379 PMCID: PMC6509873 DOI: 10.1186/s12859-019-2741-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Haemorrhagic stroke accounts for approximately 31.52% of all stroke cases, and the most common origin is hypertension. However, little is known about the method to identify high-risk populations of hypertensive intracerebral haemorrhage. Results The results showed that the angle between the middle cerebral artery and the internal carotid artery (AMIC), the distance between the beginning of the median artery and superior trunk (DMS), and the density (CT value) of the lenticulostriate artery (CTL) were statistically significant enough to cause intracerebral haemorrhage. In addition, we chose these three potential features for the ensemble learning classification model. Our developed ensemble-learning method outperforms not only previous work but also three other classic classification methods based on accuracy measurements. Conclusions The developed mathematical model in the present study is efficient in predicting the probability of intracerebral haemorrhage. Electronic supplementary material The online version of this article (10.1186/s12859-019-2741-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Le Zhang
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China. .,College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China. .,Medical Big Data Center, Sichuan University, Chengdu, 610065, People's Republic of China.
| | - Jin Li
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China.,School of Medical Information and Engineering, Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Kaikai Yin
- College of Computer and Information Science, Southwest University, Chongqing, 400715, People's Republic of China
| | - Zhouyang Jiang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Tingting Li
- School of Mathematics and Statistics, Southwest University, Chongqing, 400715, People's Republic of China
| | - Rong Hu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Zheng Yu
- Department of Neurosurgery, Fuling Central Hospital, Chongqing, 400715, People's Republic of China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.
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Cheng HY, Huang LC, Peng HF, Kuo JS, Liew HK, Pang CY. Delayed formation of hematomas with ethanol preconditioning in experimental intracerebral hemorrhage rats. Tzu Chi Med J 2018; 30:5-9. [PMID: 29643709 PMCID: PMC5883839 DOI: 10.4103/tcmj.tcmj_184_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: Spontaneous intracerebral hemorrhage (ICH) accounts for 10%–15% of all strokes and causes high mortality and morbidity. In the previous study, we demonstrated that ethanol could aggravate the severity of brain injury after ICH by increasing neuroinflammation and oxidative stress. In this study, we further investigate the acute effects of ethanol on brain injury within 24 h after ICH. Materials and Methods: Totally, 66 male Sprague-Dawley rats were assigned randomly into two groups: saline pretreatment before ICH (saline + ICH), and ethanol pretreatment before ICH (ethanol + ICH). Normal saline (10 mL/kg) or ethanol (3 g/kg, in 10 mL/kg normal saline) was administered intraperitoneally 1 h before induction of experimental ICH. Bacterial collagenase VII-S (0.23 U in 1.0 μL sterile saline) was injected into the right striatum to induce ICH in the rats. We evaluated the hematoma expansion, hemodynamic parameters (heart rate and blood pressure), activated partial thromboplastin time (aPTT), prothrombin time (PT), and striatal matrix metallopeptidase 9 (MMP-9) expressions at 3, 6, 9, and 24 h after ICH. Results: The ethanol + ICH group exhibited decreased hematoma at 3 h after ICH; nevertheless, there was a larger hematoma compared with the saline + ICH group at 9 and 24 h after ICH. The ethanol + ICH group had lower blood pressure at 3, 6, and 9 h post-ICH, but both groups maintained similar heart rates after ICH. There was no significant difference in the aPTT and PT between the two groups. Incremental ethanol concentrations had no influence on collagenase VII-S activity at 120 min in vitro. MMP-9 expression was upregulated in the right striata of the ethanol + ICH group, especially at 3 and 9 h after ICH. Conclusion: Ethanol delayed hematoma formation in the first 3 h due to a hypotensive effect; however, the accelerated growth of hematomas after 9 h may be a sequela of ethanol-induced MMP-9 activation.
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Affiliation(s)
- Hung-Yu Cheng
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Li-Chuan Huang
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Department of Radiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hsiao-Fen Peng
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jon-Son Kuo
- Master Program and PhD Program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan
| | - Hock-Kean Liew
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Cheng-Yoong Pang
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Rannikmäe K, Woodfield R, Anderson CS, Charidimou A, Chiewvit P, Greenberg SM, Jeng JS, Meretoja A, Palm F, Putaala J, Rinkel GJ, Rosand J, Rost NS, Strbian D, Tatlisumak T, Tsai CF, Wermer MJ, Werring D, Yeh SJ, Al-Shahi Salman R, Sudlow CL. Reliability of intracerebral hemorrhage classification systems: A systematic review. Int J Stroke 2016; 11:626-36. [PMID: 27091144 DOI: 10.1177/1747493016641962] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/04/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accurately distinguishing non-traumatic intracerebral hemorrhage (ICH) subtypes is important since they may have different risk factors, causal pathways, management, and prognosis. We systematically assessed the inter- and intra-rater reliability of ICH classification systems. METHODS We sought all available reliability assessments of anatomical and mechanistic ICH classification systems from electronic databases and personal contacts until October 2014. We assessed included studies' characteristics, reporting quality and potential for bias; summarized reliability with kappa value forest plots; and performed meta-analyses of the proportion of cases classified into each subtype. SUMMARY OF REVIEW We included 8 of 2152 studies identified. Inter- and intra-rater reliabilities were substantial to perfect for anatomical and mechanistic systems (inter-rater kappa values: anatomical 0.78-0.97 [six studies, 518 cases], mechanistic 0.89-0.93 [three studies, 510 cases]; intra-rater kappas: anatomical 0.80-1 [three studies, 137 cases], mechanistic 0.92-0.93 [two studies, 368 cases]). Reporting quality varied but no study fulfilled all criteria and none was free from potential bias. All reliability studies were performed with experienced raters in specialist centers. Proportions of ICH subtypes were largely consistent with previous reports suggesting that included studies are appropriately representative. CONCLUSIONS Reliability of existing classification systems appears excellent but is unknown outside specialist centers with experienced raters. Future reliability comparisons should be facilitated by studies following recently published reporting guidelines.
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Affiliation(s)
| | | | - Craig S Anderson
- The George Institute for Global Health, Royal Prince Alfred Hospital and the University of Sydney, Australia
| | - Andreas Charidimou
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UK
| | - Pipat Chiewvit
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | | | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan
| | - Atte Meretoja
- Department of Neurology, Helsinki University Central Hospital, Finland Departments of Medicine and the Florey, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Frederic Palm
- Department of Neurology, Städtisches Klinikum Ludwigshafen, Germany
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Finland
| | - Gabriel Je Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, USA Center for Human Genetic Research, Massachusetts General Hospital, USA Program in Medical and Population Genetics, Broad Institute, USA
| | - Natalia S Rost
- Center for Human Genetic Research, Massachusetts General Hospital, USA
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Finland Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden Department of Neurology, Sahlgrenska University Hospital, Sweden
| | - Chung-Fen Tsai
- Department of Neurology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, Taiwan
| | - Marieke Jh Wermer
- Department of Neurology, Leiden University Medical Center, The Netherlands
| | - David Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UK
| | - Shin-Joe Yeh
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan
| | | | - Cathie Lm Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, UK Institute for Genetics and Molecular Medicine, University of Edinburgh, UK UK Biobank, UK
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In-hospital mortality after pre-treatment with antiplatelet agents or oral anticoagulants and hematoma evacuation of intracerebral hematomas. J Clin Neurosci 2016; 26:42-5. [DOI: 10.1016/j.jocn.2015.05.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 05/22/2015] [Indexed: 11/20/2022]
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Defining Prolonged Length of Acute Care Stay for Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Hemorrhage: A Population-Based Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9095263. [PMID: 27110572 PMCID: PMC4826712 DOI: 10.1155/2016/9095263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/09/2016] [Accepted: 03/07/2016] [Indexed: 11/17/2022]
Abstract
Background. The definition of prolonged length of stay (LOS) during acute care remains unclear among surgically and conservatively treated patients with intracerebral hemorrhage (ICH). Methods. Using a population-based quality assessment registry, we calculated change points in LOS for surgically and conservatively treated patients with ICH. The influence of comorbidities, baseline characteristics at admission, and in-hospital complications on prolonged LOS was evaluated in a multivariate model. Results. Overall, 13272 patients with ICH were included in the analysis. Surgical therapy of the hematoma was documented in 1405 (10.6%) patients. Change points for LOS were 22 days (CI: 8, 22; CL 98%) for surgically treated patients and 16 days (CI: 16, 16; CL: 99%) for conservatively treated patients. Ventilation therapy was related to prolonged LOS in surgically (OR: 2.2, 95% CI: 1.5–3.1; P < 0.001) and conservatively treated patients (OR: 2.5, 95% CI: 2.2–2.9; P < 0.001). Two or more in-hospital complications in surgical patients (OR: 2.7, 95% CI: 2.1–3.5) and ≥1 in conservative patients (OR: 3.0, 95% CI: 2.7–3.3) were predictors of prolonged LOS. Conclusion. The definition of prolonged LOS after ICH could be useful for several aspects of quality management and research. Preventing in-hospital complications could decrease the number of patients with prolonged LOS.
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In-Hospital Mortality and Complication Rates in Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Hemorrhage in Central Europe: A Population-Based Study. World Neurosurg 2015; 88:306-310. [PMID: 26739904 DOI: 10.1016/j.wneu.2015.11.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Secondary complications (SC) after intracerebral hemorrhage (ICH) can worsen outcome and are associated with early death. The purpose of the present study was to determine in-hospital mortality rates and SC after spontaneous ICH during acute care stay in a population-based cohort in central Europe. METHODS A prospective database of the State of Hesse, Germany, was screened for all patients with the primary diagnosis of spontaneous ICH (International statistical classification-10: I61.0-I61.9) between January 2007 and December 2012. RESULTS In the examined time period 10,029 patients with spontaneous ICH were identified. The cumulative rate of SC was 39.9% (1, 2, or ≥3 SC were documented in 25.0%, 10.1%, and 4.7%, respectively). The most common SC were pneumonia (15.1%), brain edema (6.5%), cardiac decompensation (5.9%), urogenital infection (5.5%), hydrocephalus (4.6%), epilepsy (3.4%), and rebleeding (3.4%). One, 2, or ≥3 SC were found in 2512 patients (25.0%), 1012 (10.1%), 473 (4.7%) patients, respectively. One SC was only a predictor of in-hospital mortality in conservatively treated patients (odds ratio [OR], 1.3; 95% confidence interval [CI] 1.2-1.5, P< 0.001). With an accumulation of SC to ≥3 the chance of in-hospital death increases for surgically (OR, 3.7, 95% CI 2.3-5.9; P< 0.001) and conservatively (OR, 3.0, 95% CI 2.3-3.9; P< 0.001) treated patients. CONCLUSIONS Surgical treatment of hematomas is associated with an increased rate of SC, but not with higher mortality rates compared with conservatively treated patients. The prevention of an accumulation of SC could lead to a decrease of in-hospital mortality after spontaneous ICH.
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Stephan BCM, Tzourio C, Auriacombe S, Amieva H, Dufouil C, Alpérovitch A, Kurth T. Usefulness of data from magnetic resonance imaging to improve prediction of dementia: population based cohort study. BMJ 2015; 350:h2863. [PMID: 26099688 PMCID: PMC4476487 DOI: 10.1136/bmj.h2863] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether the addition of data derived from magnetic resonance imaging (MRI) of the brain to a model incorporating conventional risk variables improves prediction of dementia over 10 years of follow-up. DESIGN Population based cohort study of individuals aged ≥ 65. SETTING The Dijon magnetic resonance imaging study cohort from the Three-City Study, France. PARTICIPANTS 1721 people without dementia who underwent an MRI scan at baseline and with known dementia status over 10 years' follow-up. MAIN OUTCOME MEASURE Incident dementia (all cause and Alzheimer's disease). RESULTS During 10 years of follow-up, there were 119 confirmed cases of dementia, 84 of which were Alzheimer's disease. The conventional risk model incorporated age, sex, education, cognition, physical function, lifestyle (smoking, alcohol use), health (cardiovascular disease, diabetes, systolic blood pressure), and the apolipoprotein genotype (C statistic for discrimination performance was 0.77, 95% confidence interval 0.71 to 0.82). No significant differences were observed in the discrimination performance of the conventional risk model compared with models incorporating data from MRI including white matter lesion volume (C statistic 0.77, 95% confidence interval 0.72 to 0.82; P=0.48 for difference of C statistics), brain volume (0.77, 0.72 to 0.82; P=0.60), hippocampal volume (0.79, 0.74 to 0.84; P=0.07), or all three variables combined (0.79, 0.75 to 0.84; P=0.05). Inclusion of hippocampal volume or all three MRI variables combined in the conventional model did, however, lead to significant improvement in reclassification measured by using the integrated discrimination improvement index (P=0.03 and P=0.04) and showed increased net benefit in decision curve analysis. Similar results were observed when the outcome was restricted to Alzheimer's disease. CONCLUSIONS Data from MRI do not significantly improve discrimination performance in prediction of all cause dementia beyond a model incorporating demographic, cognitive, health, lifestyle, physical function, and genetic data. There were, however, statistical improvements in reclassification, prognostic separation, and some evidence of clinical utility.
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Affiliation(s)
| | - Christophe Tzourio
- Inserm Research Centre for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, F-33000 Bordeaux, France University of Bordeaux, College of Health Sciences, F-33000 Bordeaux, France
| | - Sophie Auriacombe
- University Hospital, Department of Neurology, Memory Consultation, CMRR, F-33000 Bordeaux, France
| | - Hélène Amieva
- Inserm Research Centre for Epidemiology and Biostatistics (U897), Team Epidemiology and Neuropsychology of Brain Aging, F-33000 Bordeaux, France
| | - Carole Dufouil
- Inserm Research Centre for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, F-33000 Bordeaux, France University of Bordeaux, College of Health Sciences, F-33000 Bordeaux, France
| | - Annick Alpérovitch
- Inserm Research Centre for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, F-33000 Bordeaux, France
| | - Tobias Kurth
- Inserm Research Centre for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, F-33000 Bordeaux, France University of Bordeaux, College of Health Sciences, F-33000 Bordeaux, France
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Easton JF, Stephens CR, Angelova M. Risk factors and prediction of very short term versus short/intermediate term post-stroke mortality: A data mining approach. Comput Biol Med 2014; 54:199-210. [DOI: 10.1016/j.compbiomed.2014.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 08/17/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
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George AJ, Boehme AK, Dunn CR, Beasley T, Siegler JE, Albright KC, El Khoury R, Martin-Schild S. Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients. Int J Stroke 2014; 10:37-41. [PMID: 24894300 DOI: 10.1111/ijs.12293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/02/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND International management of acute ischemic stroke patients treated with intravenous tissue plasminogen activator frequently includes 24-h head imaging. These recommendations stem from the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial protocol regarding the risk of intracerebral hemorrhage post-tissue plasminogen activator administration. Follow-up computed tomography scans on select patients, however, may not effect clinical management, resulting in unnecessary radiation exposure and healthcare costs. AIMS Our study questions the utility of routine 24-h computed tomography imaging and looks at the National Institute of Health Stroke Scale as a possible clinical screen for selecting candidates for 24-h imaging. Such a tool would result in decreased radiation exposure to the patient and decreased cost to the hospital. METHODS Consecutive patients with acute ischemic stroke given intravenous tissue plasminogen activator between June 2008 and December 2011 were retrospectively identified and dichotomized based on change in 24-h National Institute of Health Stroke Scale from baseline. Initial analysis compared patients with National Institute of Health Stroke Scale worsening to those without worsening. Subsequent analysis was limited to patients with a baseline National Institute of Health Stroke Scale ≤10. Baseline demographics and medical history, baseline and 24-h computed tomography findings, medical and/or surgical orders within six-hours of imaging, and antithrombotic administration within 24-48-h postintravenous tissue plasminogen activator were compared between the two groups. RESULTS Two-hundred patients met inclusion criteria: No 24-h National Institute of Health Stroke Scale worsening (n = 167) vs. 24-h National Institute of Health Stroke Scale worsening (n = 33). No baseline demographic or admission data differed significantly between the two groups. Patients without 24-h National Institute of Health Stroke Scale worsening had significantly lower incidence of hemorrhagic infarction (10·8% vs. 31·3%, P = 0·0014) on follow-up imaging. Less than 2% of all patients without 24-h National Institute of Health Stroke Scale worsening had a parenchymal hematoma. No patient with baseline National Institute of Health Stroke Scale ≤10 and without 24-h National Institute of Health Stroke Scale worsening had parenchymal hematoma. Patients with 24-h worsening were significantly less likely to receive timely antithrombotic therapy (60·6% vs. 77·8%, odds ratio 0·44, 95% confidence interval 0·20-0·96). CONCLUSIONS Our results demonstrate that routine 24-h computed tomography scan in patients without 24-h National Institute of Health Stroke Scale worsening (especially those with baseline National Institute of Health Stroke Scale ≤10) is less likely to yield information that results in a deviation from standard acute stroke care. No patient without worsening and baseline National Institute of Health Stroke Scale ≤10 had parenchymal hematoma on 24-h computed tomography. Application of the National Institute of Health Stroke Scale to distinguish patients who should have 24-h follow-up imaging from those who will not benefit is a potential avenue for improving utilization of resources and warrants further study.
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Affiliation(s)
- Alexander J George
- Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, LA, USA
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Zahuranec DB, Lisabeth LD, Sánchez BN, Smith MA, Brown DL, Garcia NM, Skolarus LE, Meurer WJ, Burke JF, Adelman EE, Morgenstern LB. Intracerebral hemorrhage mortality is not changing despite declining incidence. Neurology 2014; 82:2180-6. [PMID: 24838789 DOI: 10.1212/wnl.0000000000000519] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study. METHODS We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases. Age-, sex-, and ethnicity-adjusted incidence was estimated for each year with Poisson regression, and a linear trend over time was investigated. Trends in 30-day case fatality and long-term mortality (censored at 3 years) were estimated with log-binomial or Cox proportional hazards models adjusted for demographics, stroke severity, and comorbid disease. RESULTS A total of 734 cases of ICH were included. The age-, sex-, and ethnicity-adjusted ICH annual incidence rate was 5.21 per 10,000 (95% confidence interval [CI] 4.36, 6.24) in 2000 and 4.30 per 10,000 (95% CI 3.21, 5.76) in 2010. The estimated 10-year change in demographic-adjusted ICH annual incidence rate was -31% (95% CI -47%, -11%). Yearly demographic-adjusted 30-day case fatality ranged from 28.3% (95% CI 19.9%, 40.3%) in 2006 to 46.5% (95% CI 35.5, 60.8) in 2008. There was no change in ICH case fatality or long-term mortality over time. CONCLUSIONS ICH incidence decreased over the past decade, but case fatality and long-term mortality were unchanged. This suggests that primary prevention efforts may be improving over time, but more work is needed to improve ICH treatment and reduce the risk of death.
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Affiliation(s)
- Darin B Zahuranec
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
| | - Lynda D Lisabeth
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Brisa N Sánchez
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Melinda A Smith
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Devin L Brown
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Nelda M Garcia
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Lesli E Skolarus
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - William J Meurer
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - James F Burke
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Eric E Adelman
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Lewis B Morgenstern
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
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Gender and age interact to affect early outcome after intracerebral hemorrhage. PLoS One 2013; 8:e81664. [PMID: 24312335 PMCID: PMC3842307 DOI: 10.1371/journal.pone.0081664] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/15/2013] [Indexed: 11/19/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a common and devastating form of cerebrovascular disease. In ICH, gender differences in outcomes remain relatively understudied but have been examined in other neurological emergencies. Further, a potential effect of age and gender on outcomes after ICH has not been explored. This study was designed to test the hypothesis that age and gender interact to modify neurological outcomes after ICH. Methods Adult patients admitted with spontaneous primary supratentorial ICH from July 2007 through April 2010 were assessed via retrospective analysis of an existing stroke database at Duke University. Univariate analysis of collected variables was used to compare gender and outcome. Unfavorable outcome was defined as discharge to hospice or death. Using multivariate regression, the combined effect of age and gender on outcome after ICH was analyzed. Results In this study population, women were younger (61.1+14.5 versus 65.8+17.3 years, p=0.03) and more likely to have a history of substance abuse (35% versus 8.9%, p<0.0001) compared to men. Multivariable models demonstrated that advancing age had a greater effect on predicting discharge outcome in women compared to men (p=0.02). For younger patients, female sex was protective; however, at ages greater than 60 years, female sex was a risk factor for discharge to hospice or death. Conclusion While independently associated with discharge to hospice or death after ICH, the interaction effect between gender and age demonstrated significantly stronger correlation with early outcome after ICH in a single center cohort. Prospective study is required to verify these findings.
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Hjalmarsson C, Bergfeldt L, Bokemark L, Manhem K, Andersson B. Electrocardiographic abnormalities and elevated cTNT at admission for intracerebral hemorrhage: predictors for survival? Ann Noninvasive Electrocardiol 2013; 18:441-9. [PMID: 24047488 DOI: 10.1111/anec.12056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cerebrovascular lesions are often associated with electrocardiographic (ECG) abnormalities. The main purpose of this work was to investigate the prognostic value of ECG abnormalities and/or elevated cardiac troponin (cTNT) on admission in patients with nontraumatic intracerebral hemorrhage (ICH). METHODS Ninety-seven consecutive patients with ICH were included. The predictive value of ECG abnormalities and increased TNT on survival were evaluated using Cox proportional hazard model. RESULTS The most frequently observed ECG abnormalities were the presence of a Q wave (39.6%), followed by prolonged QTc (>0.44 s; 35.4%), which was an independent predictor for long-term mortality (P = 0.019). No difference in QTc was observed between patients with right versus left ICH. Increased cTNT levels at admission had no prognostic value. CONCLUSION Various ECG changes were common in patients presenting with an ICH, but only prolonged QTc was found to be an independent predictor of poor survival during follow-up after ICH.
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Affiliation(s)
- Clara Hjalmarsson
- Stroke Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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