Long-term mortality in survivors of spontaneous intracerebral hemorrhage

Factors associated with long-term mortality after spontaneous intracerebral hemorrhage (ICH) have been poorly investigated.

Our objective was to identify variables associated with long-term mortality in a prospective cohort of 30-day ICH survivors.

We prospectively included consecutive 30-day spontaneous ICH survivors. We evaluated baseline and follow-up clinical characteristics and magnetic resonance imaging (MRI) markers of chronic brain injury as variables associated with long-term mortality using univariate and multivariable Cox proportional hazard regression models.

Of 560 patients with spontaneous ICH, 304 (54.2%) survived more than 30 days and consented for follow-up. During a median follow-up of 10 years (interquartile range: 8.0-10.5), 176 patients died. The cumulative survival rate at 10 years was 38%. In multivariable analysis, variables independently associated with long-term mortality were age (hazard ratio (HR) per 10-year increase: 1.68, 95% confidence interval (CI): 1.45-1.95), male gender (HR: 1.41, CI: 1.02-1.95), prestroke dependency (HR: 1.66, CI: 1.15-2.39), National Institutes of Health Stroke Scale score (HR per 1-point increase: 1.03, CI: 1.01-1.04), occurrence of any stroke (HR: 2.24, CI: 1.39-3.60), and dementia (HR: 1.51, CI: 1.06-2.16) during follow-up. Among MRI markers, only cerebral atrophy (HR per 1-point increase: 1.50, CI: 1.13-2.00) was independently associated with long-term mortality.

Preexisting comorbidities, clinical severity at presentation, and significant clinical event during follow-up are associated with long-term mortality. Among MRI markers of chronic brain injury, only cerebral atrophy is associated with long-term mortality.