Study provides insights into how risk factors following ICH stroke may affect patient outcomes

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A new study by researchers at the University of Cincinnati provides new insights into how different risk factors following one of the most serious types of stroke can affect patient outcomes.

Daniel Woo, MD said that intracerebral hemorrhage (ICH) is caused when a blood vessel bursts inside the brain and causes bleeding in the brain. ICH strokes are often fatal and can lead to high neurological disability.

So far, many different factors have been generally reported to be associated with a higher likelihood of disability or death from ICH stroke, but Woo said there is a need for more data. specific.

To learn more, Woo conducted a cohort study analyzing outcome data three months after an ICH event in one of the largest prospectively recruited patient groups, which included 1,000 non-Hispanic white patients, 1,000 non-Hispanic blacks and 1,000 Hispanic patients. The results of the study were recently published in JAMA.

New perspectives

One of the avenues used by researchers to assess risk factors was two clinical rating scales that were developed previously.

Woo said both rating scales are easy to calculate and take multiple variables such as age and size, location and severity of hemorrhage to assign a point value to the patient, one of the scales further considering whether a patient had cognitive impairment prior to the hemorrhage. A higher point value using the scales is designed to correlate with a prediction of higher death rates.

In this study, Woo said high scores on both scales were confirmed for the first time to correlate with increased mortality rates in black and Hispanic populations after being previously verified in a patient dataset at predominantly white. Each individual variable that makes up each score, as well as certain markers found on brain scans, were also found to be associated with poor outcomes for all patient ethnicities.

Scores like these are easy to learn and apply, but they obviously don’t reflect the wide variation between patients. For me, adding some basic CT scan variables to admission would improve these scores significantly.”


Daniel Woo, vice chair of research in the UC Department of Neurology and UC Health Physician at the UC Gardner Neuroscience Institute

Although rating scales are useful for comparing large numbers of patients to predict outcomes, Woo said physicians should use more than scores to predict outcomes and guide care decisions. The researchers analyzed a total of 76 distinct risk factors for association with good or poor patient outcomes to provide a more complete picture.

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

The study found that larger hemorrhages were correlated with a greater likelihood of death, but black and Hispanic patients were still more likely to die than white patients with similar hemorrhage sizes. Woo said further study needs to be done to find the reason for this disparity.

Clinical applications

Woo said some of the study’s most intriguing findings were the effect of events that happened after patients were admitted to hospital.

“Most of the previous outcomes were reported based on when the patient first arrived at the hospital, but we found that many complications occurring during hospitalization had a marked impact on the outcomes,” said he declared.

The researchers found that patients who developed infections during a hospital stay were more than three times more likely to be severely disabled or die. Patients whose hematoma, or collection of blood in the brain, developed during their hospital stay were 1.6 times more likely to have a poor outcome.

“These had very strong effects and may be things we can intervene on to improve outcomes,” Woo said.

With the correlation between these variables and outcomes now better understood, Woo said physicians can leverage insights from this study to make more informed decisions when caring for individual patients.

“Our research provides a wide variety of antecedents, signs and subsequent events that can affect outcomes after ICH that clinicians can now incorporate into their assessment,” he said. “It also provides the relative strength of each variable that they can factor into their assessments. Additionally, many of these may be targets for which we can design treatments through research to improve outcomes. results in the future.”

Source:

Journal reference:

Wood., et al. (2022) Risk factors associated with mortality and neurological disability after intracerebral hemorrhage in a racially and ethnically diverse cohort. JAMA. doi.org/10.1001/jamanetworkopen.2022.1103.

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