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Published on: June 18, 2021
Cause of death in spontaneous intracerebral hemorrhage survivors: Multistate longitudinal study
Lindsey R Kuohn1, Audrey C Leasure1, Julian N Acosta1
1From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
Insights
Infection is the primary cause of death for intracerebral hemorrhage (ICH) survivors. Atrial fibrillation increases stroke risk, highlighting the need for targeted interventions to improve long-term outcomes.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Intracerebral hemorrhage (ICH) survivors face significant long-term mortality risks.
- Identifying leading causes of death is crucial for developing effective post-discharge care strategies.
Purpose of the Study:
- To identify the primary causes of mortality among adult survivors of a first-time spontaneous intracerebral hemorrhage (ICH).
- To analyze the association between pre-existing conditions, such as atrial fibrillation, and specific causes of death in ICH survivors.
Main Methods:
- Longitudinal analysis of administrative claims data from 72,432 adult ICH survivors across three large US states (California, New York, Florida) from 2005-2014.
- Follow-up for hospital readmissions resulting in death, with causes determined by primary discharge diagnosis.
- Multivariable Cox proportional hazards and multinomial logistic regression models were employed to assess risk factors and causes of death.
Main Results:
- Infection emerged as the leading cause of death (34%) among ICH survivors, followed by recurrent intracranial hemorrhage (14%), cardiac disease (8%), respiratory failure (8%), and ischemic stroke (5%).
- A significant association was observed between atrial fibrillation (AF) and increased risk of death from ischemic stroke (OR 2.4, 95% CI 1.9-2.9).
- Conversely, patients with AF had a reduced likelihood of dying from recurrent ICH compared to those without AF (OR 0.7, 95% CI 0.6-0.8).
Conclusions:
- Infection represents the foremost cause of mortality in individuals who have survived an intracerebral hemorrhage.
- Atrial fibrillation is a critical risk factor for cerebrovascular events, specifically increasing the risk of death from ischemic stroke in ICH survivors.
- These findings underscore the necessity of prioritizing interventions focused on preventing infections and managing cardiovascular risks to enhance long-term survival and recovery in the ICH patient population.
Objective:
To determine the leading causes of death in intracerebral hemorrhage (ICH) survivors, we used administrative data from 3 large US states to identify adult survivors of a first-time spontaneous ICH and track all hospital readmissions resulting in death.
Methods:
We performed a longitudinal analysis of prospectively collected claims data from hospitalizations in California (2005-2011), New York (2005-2014), and Florida (2005-2014). Adult residents admitted with a nontraumatic ICH who survived to discharge were included. Patients were followed for a primary outcome of any readmission resulting in death. The cause of death was defined as the primary diagnosis assigned at discharge. Multivariable Cox proportional hazards and multinomial logistic regression were used to determine factors associated with the risk for and cause of death.
Results:
Of 72,432 ICH survivors (mean age 68 years [SD 16], 48% female), 12,753 (18%) died during a median follow-up period of 4.0 years (interquartile range 2.3-6.3). The leading causes of death were infection (34%), recurrent intracranial hemorrhage (14%), cardiac disease (8%), respiratory failure (8%), and ischemic stroke (5%). Death in patients with atrial fibrillation (AF) was more likely to be caused by ischemic stroke (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.9-2.9, p < 0.001) and less likely to be caused by recurrent intracranial hemorrhage (OR 0.7, 95% CI 0.6-0.8, p < 0.001) compared to patients without AF.
Conclusions:
Infection is the leading cause of death in all ICH survivors. Survivors with AF were at increased risk for death from ischemic stroke. These findings will help prioritize interventions aimed to improve long-term survival and recovery in ICH survivors.
