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Updated: Jan 1, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort
Maria Antonia González-Henares1,2, Jose Luis Clua-Espuny3,4, Blanca Lorman-Carbo5
1EAP-Alcanar-St Carlos de la Rápita, Catalonian Health Institute, SAP Terres de l'Ebre, Health Department, Generalitat de Catalunya, CAP St Carles de la Rápita, 43540, Sant Carles de la Ràpita, Spain.
Insights
A new prognostic tool shows promise for predicting mortality after hemorrhagic stroke in primary care. However, its effectiveness was not confirmed in complex chronic patients.
Area of Science:
- Gerontology
- Neurology
- Public Health
Background:
- Hemorrhagic stroke (ICH) poses a significant mortality risk, particularly in older adults.
- Accurate prognostic tools are crucial for managing complex chronic patients post-ICH in primary care settings.
Purpose of the Study:
- To develop and validate a prognostic life table for complex chronic patients following an intracerebral hemorrhage (ICH) episode.
- To assess the predictive accuracy of a novel clinical scale (ICH-AP) for mortality in primary care patients post-ICH.
Main Methods:
- A multicenter, retrospective study identified a cohort of older adults (≥65 years) with ICH.
- Cox regression, Kaplan-Meier curves, and ROC analysis were used to develop and validate a mortality prediction model.
- External validation was performed using prospective monitoring of complex chronic patients.
Main Results:
- The study identified age >80 years and HAS-BLED score as independent predictors of mortality post-ICH.
- The developed model (ICH-AP) showed optimal internal validation in the general population.
- External validation of the ICH-AP model in complex chronic patients was not statistically significant (log-rank p=0.104).
Conclusions:
- The ICH-AP clinical scale may enhance prognostic prediction for general populations post-ICH in primary care.
- The prognostic tool's effectiveness was not validated in the complex chronic patient population.
- Further research is needed to refine prognostic models for complex chronic patients post-ICH.
Introduction:
Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings.
Methods:
This was a multicenter and retrospective study (April 1, 2006-December 31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan-Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January 1, 2013-December 31, 2017) of the population of complex chronic patients with an episode of ICH.
Results:
A total of 3594 people aged ≥ 65 years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4 years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013-December 31, 2017). The primary outcome was death from any cause within 5 years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80 years (HR 1.048, 95% CI 1.021-1.076, p < 0.001) and HAS-BLED score (HR 1.369, 95% CI 1.057-1.774, p = 0.017). Compared to the general population, the incidence density/1000 person per year (15 vs 0.22) was significantly higher with a significantly lower annual lethality rate (17% vs 49.2%); and both the prognostic factors and the risk of stratified mortality showed different epidemiological patterns. The internal validation of the model was optimal (log-rank < 0.0001) in the general population, but its external validation was not significant in the complex chronic patient population (log-rank p = 0.104).
Conclusions:
The ICH-AP is a clinical scale that can improve the prognostic prediction of mortality in primary care after an episode of ICH in the general population, but it was not significant in its external validation in a population of complex chronic patients.
Trial Registration:
ClinicalTrials.gov ID: NCT03247049.
