"JAMA" Risk factors for stroke in cerebral hemorrhage

A new study led by University of Cincinnati researchers provides new insights into how different risk factors affect patient outcomes for one of the most severe types of stroke

Intracerebral hemorrhage (ICH) occurs when a blood vessel in the brain ruptures, says Daniel Woo, MD

So far, a number of different factors have been generally reported to be associated with a higher likelihood of disability or death following a stroke after intracerebral hemorrhage, but Woo said more specific data is needed

To learn more, Woo led a cohort study analyzing outcome data three months after intracerebral hemorrhage, one of the largest prospectively recruited patients ever, including 1,000 non-Hispanic whites, 1,000 non-Hispanic blacks and 1000 Hispanic patients

new insights

One of the avenues the researchers used to assess risk factors was two clinical grading scales, which were previously developed

Prof Woo said: "Both scales are easy to calculate, taking into account age and multiple variables such as the size, location and severity of the bleeding, and one of the scales can also take into account the presence of cognitive impairment prior to the bleeding

In this study, high scores on both scales were first shown to be associated with increased mortality in black and Hispanic populations following validation on a previous dataset of white patients

"Scores like this are easy to learn and apply, but they clearly don't capture the large differences between patients," said Professor Woo, vice chair for research in neurology at the University of California, Calif.

Although grading scales are useful when comparing large numbers of patients to predict treatment outcomes, Prof Woo said physicians should use more than just scores to predict treatment outcomes and guide treatment decisions

The researchers found that a previous history of ischemic stroke (when a blood vessel supplying blood to the brain is blocked) or atrial fibrillation (a type of irregular heartbeat) nearly doubled the likelihood of severe disability or death

The study found that the larger the bleeding, the greater the likelihood of death, but black and Hispanic patients were even more likely to die than white patients with similar bleeds

Clinical application

Professor Woo said some of the most intriguing results from the study were the effects of events that occurred after patients were admitted to hospital

"Most previous findings have been reported based on when patients first came to the hospital, but we found that many complications that occurred during hospital stay had a significant impact on outcomes,

The researchers found that patients who developed an infection during hospitalization were more than three times more likely to be severely disabled or die

"These have very strong effects, and maybe we can intervene to improve outcomes," Woo said
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With the correlations between these variables and outcomes now better understood, Woo said, physicians can gain knowledge from this study to make more informed decisions when caring for individual patients
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"Our study provides a wide variety of past histories, signs and subsequent events that can influence outcomes after ICH that clinicians can now incorporate into their assessments," he said
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"It also provides the relative strength of each variable, which they can incorporate into their assessments
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Additionally, many of these may be targets that we can study to design treatment regimens to improve future outcomes
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