Intracerebral hemorrhage location and outcome among INTERACT2 participants

Candice Delcourt, Shoichiro Sato, Shihong Zhang, Else Charlotte Sandset, Danni Zheng, Xiaoying Chen, Maree L Hackett, Hisatomi Arima, Jun Hata, Emma Heeley, Rustam Al-Shahi Salman, Thompson Robinson, Leo Davies, Pablo M Lavados, Richard I Lindley, Christian Stapf, John Chalmers, Craig S Anderson, INTERACT2 Investigators

Abstract

Objective: To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).

Methods: Associations between ICH sites and poor outcomes (death [6] or major disability [3-5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models.

Results: Of 2,066 patients included in the analyses, associations were identified between ICH sites and poor outcomes: involvement of posterior limb of internal capsule increased risks of death or major disability (odds ratio [OR] 2.10) and disability (OR 1.81); thalamic involvement increased risks of death or major disability (OR 2.24) and death (OR 1.97). Involvement of the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor EQ-5D utility score (≤0.7 [median]; OR 1.87, 2.14, and 2.81, respectively). Posterior limb of internal capsule involvement was strongly associated with low scores across all health-related quality of life domains. ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability, major disability, and poor EQ-5D utility score (OR 1.72, 2.26, and 1.71, respectively).

Conclusion: Poor clinical outcomes are related to ICH affecting the posterior limb of internal capsule, thalamus, and infratentorial sites. The highest association with death or major disability and poor EQ-5D utility score was seen in ICH encompassing the thalamus and posterior limb of internal capsule.

Clinicaltrialsgov registration: NCT00716079.

Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

References

    1. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001;32:891–897.
    1. Flaherty ML, Haverbusch M, Sekar P, et al. . Long-term mortality after intracerebral hemorrhage. Neurology 2006;66:1182–1186.
    1. Chen G, Arima H, Wu G, et al. . Subarachnoid extension of intracerebral hemorrhage and 90-day outcomes in INTERACT2. Stroke 2014;45:258–260.
    1. Rost NS, Smith EE, Chang Y, et al. . Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke 2008;39:2304–2309.
    1. Samarasekera N, Fonville A, Lerpiniere C, et al. . Influence of intracerebral hemorrhage location on incidence, characteristics, and outcome: population-based study. Stroke 2015;46:361–368.
    1. Anderson CS, Heeley E, Huang Y, et al. . Blood-pressure lowering in acute intracerebral hemorrhage. N Engl J Med 2013;368:2355–2365.
    1. EuroQol G. EuroQol: a new facility for the measurement of health-related quality of life. Health policy 1990;16:199–208.
    1. Luo N, Johnson JA, Shaw JW, Feeny D, Coons SJ. Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index. Med Care 2005;43:1078–1086.
    1. Hoi le V, Chuc NT, Lindholm L. Health-related quality of life, and its determinants, among older people in rural Vietnam. BMC Public Health 2010;10:549.
    1. Burstrom K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 2001;10:621–635.
    1. Arboix A, Vall-Llosera A, Garcia-Eroles L, et al. . Clinical features and functional outcome of intracerebral hemorrhage in patients aged 85 and older. J Am Geriatr Soc 2002;50:449–454.
    1. Rådholm K, Arima H, Lindley RI, et al. . Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study. Age Ageing 2014;44:422–427.
    1. Christensen MC, Mayer S, Ferran JM. Quality of life after intracerebral hemorrhage: results of the Factor Seven for Acute Hemorrhagic Stroke (FAST) trial. Stroke 2009;40:1677–1682.
    1. Puig J, Pedraza S, Blasco G, et al. . Acute damage to the posterior limb of the internal capsule on diffusion tensor tractography as an early imaging predictor of motor outcome after stroke. Am J Neuroradiol 2011;32:857–863.
    1. Arboix A, Comes E, Garcia-Eroles L, et al. . Site of bleeding and early outcome in primary intracerebral hemorrhage. Acta Neurol Scand 2002;105:282–288.
    1. Englander RN, Netsky MG, Adelman LS. Location of human pyramidal tract in the internal capsule: anatomic evidence. Neurology 1975;25:823–826.
    1. Sturm JW, Donnan GA, Dewey HM, et al. . Quality of life after stroke: the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2004;35:2340–2345.
    1. Arboix A, Rodriguez-Aguilar R, Oliveres M, Comes E, Garcia-Eroles L, Massons J. Thalamic haemorrhage vs internal capsule-basal ganglia haemorrhage: clinical profile and predictors of in-hospital mortality. BMC Neurol 2007;7:32.
    1. Nasreddine ZS, Saver JL. Pain after thalamic stroke: right diencephalic predominance and clinical features in 180 patients. Neurology 1997;48:1196–1199.
    1. Vartiainen N, Perchet C, Magnin M, et al. . Thalamic pain: anatomical and physiological indices of prediction. Brain 2016;139:708–722.

Source: PubMed

3
Suscribir