Baseline factors associated with early and late death in intracerebral haemorrhage survivors

Banerjee, G. and Ambler, G. and Hostettler, I. C. and Shakeshaft, C. and Lunawat, S. and Cohen, H. and Yousry, T. and Al-Shahi Salman, R. and Lip, G. Y.H. and Houlden, H. and Muir, K. W. and Jäger, H. R. and Werring, D. J. and Shaw, Louise and Harkness, Kirsty and Sword, Jane and Mohd Nor, Azlisham and Sharma, Pankaj and Kelly, Deborah and Harrington, Frances and Randall, Marc and Smith, Matthew and Mahawish, Karim and Elmarim, Abduelbaset and Esisi, Bernard and Cullen, Claire and Nallasivam, Arumug and Price, Christopher and Barry, Adrian and Roffe, Christine and Coyle, John and Hassan, Ahamad and Lovelock, Caroline and Birns, Jonathan and Cohen, David and Sekaran, L. and Parry-Jones, Adrian and Parry, Anthea and Hargroves, David and Proschel, Harald and Datta, Prabel and Darawil, Khaled and Manoj, Aravindakshan and Burn, Mathew and Patterson, Chris and Giallombardo, Elio and Smyth, Nigel and Mansoor, Syed and Anwar, Ijaz and Marsh, Rachel and Ispoglou, Sissi and Chadha, Dinesh and Prabhakaran, Mathuri and Meenakishundaram, Sanjeevikumar and O'Connell, Janice and Scott, Jon and Krishnamurthy, Vinodh and Aghoram, Prasanna and McCormick, Michael and O’Mahony, Paul and Cooper, Martin and Choy, Lillian and Wilkinson, Peter and Leach, Simon and Caine, Sarah and Burger, Ilse and Gunathilagan, Gunaratam and Guyler, Paul and Emsley, Hedley and Davis, Michelle and Manawadu, Dulka and Pasco, Kath and Mamun, Maam and Luder, Robert and Sajid, Mahmud and Anwar, Ijaz and Okwera, James and Staals, Julie and Warburton, Elizabeth and Saastamoinen, Kari and England, Timothy and Putterill, Janet and Flossman, Enrico and Power, Michael and Dani, Krishna and Mangion, David and Suman, Appu and Corrigan, John and Lawrence, Enas and Vahidassr, Djamil (2020) Baseline factors associated with early and late death in intracerebral haemorrhage survivors. European Journal of Neurology, 27 (7). pp. 1257-1263. ISSN 1351-5101

Abstract

Background and purpose: The aim of this study was to determine whether early and late death are associated with different baseline factors in intracerebral haemorrhage (ICH) survivors. Methods: This was a secondary analysis of the multicentre prospective observational CROMIS-2 ICH study. Death was defined as ‘early’ if occurring within 6 months of study entry and ‘late’ if occurring after this time point. Results: In our cohort (n = 1094), there were 306 deaths (per 100 patient-years: absolute event rate, 11.7; 95% confidence intervals, 10.5–13.1); 156 were ‘early’ and 150 ‘late’. In multivariable analyses, early death was independently associated with age [per year increase; hazard ratio (HR), 1.05, P = 0.003], history of hypertension (HR, 1.89, P = 0.038), pre-event modified Rankin scale score (per point increase; HR, 1.41, P < 0.0001), admission National Institutes of Health Stroke Scale score (per point increase; HR, 1.11, P < 0.0001) and haemorrhage volume >60 mL (HR, 4.08, P < 0.0001). Late death showed independent associations with age (per year increase; HR, 1.04, P = 0.003), pre-event modified Rankin scale score (per point increase; HR, 1.42, P = 0.001), prior anticoagulant use (HR, 2.13, P = 0.028) and the presence of intraventricular extension (HR, 1.73, P = 0.033) in multivariable analyses. In further analyses where time was treated as continuous (rather than dichotomized), the HR of previous cerebral ischaemic events increased with time, whereas HRs for Glasgow Coma Scale score, National Institutes of Health Stroke Scale score and ICH volume decreased over time. Conclusions: We provide new evidence that not all baseline factors associated with early mortality after ICH are associated with mortality after 6 months and that the effects of baseline variables change over time. Our findings could help design better prognostic scores for later death after ICH.