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Factors influencing in-hospital outcome and mortality in patients with intracerebral haemorrhage – data from the Pomeranian Stroke Register
 
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1
Collegium Medicum, Jan Kochanowski University of Kielce, Poland
 
2
Department of Neurology and Stroke Unit in Sandomierz, Jan Kochanowski University, Kielce, Poland
 
3
Regional Hospital in Kielce, Department of Neurology and Stroke Unit, Kielce, Poland
 
4
Department of Neurology and Stroke Unit, Saint Lukas Hospital in Końskie, Końskie, Poland
 
5
Centre of Medical Simulations, Medical University of Gdańsk, Gdańsk, Poland,
 
6
Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland
 
These authors had equal contribution to this work
 
 
Submission date: 2024-05-05
 
 
Final revision date: 2025-06-29
 
 
Acceptance date: 2025-07-13
 
 
Online publication date: 2026-09-18
 
 
Corresponding author
Piotr Kazimierz Sobolewski   

Collegium Medicum, Jan Kochanowski University of Kielce, Poland
 
 
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Intracerebral haemorrhage (ICH) is a critical disease usually leading to severe disability or death. The management of patients with ICH is still a serious challenge for medical services.

Aim of the research:
The aim of the study was to identify factors influencing in-hospital outcome and mortality in patients with ICH.

Material and methods:
An observational, retrospective study included 8790 patients with acute stroke, including 813 patients with ICH, who had been hospitalised in the stroke units and consequently reported to the Pomeranian Stroke Register (PRUM) in the period 2009–2013.

Results and conclusions:
Factors that affected unfavourable outcome (mRS 3-5) of patients with ICH were as follows: unknown time of ICH onset (p = 0.019); living in a rural area (p = 0.019); motor deficiency (p < 0.001); and high NIHSS score on admission to hospital (median 11 (7–16), p < 0.001). Factors that caused higher in-hospital mortality were as follows: unknown time of ICH onset (p = 0.001); living in a rural area (p = 0.023); age over 80 years (p = 0.029); atrial fibrillation (p = 0.006); disturbance of consciousness (p < 0.001); and severe neurological condition on admission to hospital according to the NIHSS (median 19 (13–23), p < 0.001). Professional activity (p = 0.01) had a favourable impact on the functional outcome. Dyslipidaemia (p = 0.001) and preliminary diagnosis of cerebral stroke (p = 0.037) were factors that decreased the in-hospital mortality rate.

Conclusions:
The in-hospital prognosis and mortality of patients with ICH depend on the place of residence, which is associated with the possibility of rapid delivery to the Stroke Unit, the severity of the neurological condition, and the coexistence of serious comorbidities.
REFERENCES (39)
1.
Koton S, Sang Y, Schneider ALC, Rosamond WD, Gottesman RF, Coresh J. Trends in stroke incidence rates in older US adults: an update from the Atherosclerosis Risk in Communities (ARIC) Cohort Study. JAMA Neurol. 2020; 77(1): 109-113.
 
2.
Aparicio HJ, Himali JJ, Satizabal CL, Pase MP, Romero JR, Kase CS, Beiser AS, Seshadri S. Temporal trends in ischemic stroke incidence in younger adults in the Framingham Study. Stroke. 2019; 50(6): 1558-1560.
 
3.
Madsen TE, Khoury JC, Leppert M, Alwell K, Moomaw CJ, Sucharew H, Woo D, Ferioli S, Martini S, Adeoye O, Kha- tri P, Flaherty M, De Los Rios La Rosa F, Mackey J, Mistry E, Demel SL, Coleman E, Jasne A, Slavin SJ, Walsh K, Star M, Broderick JP, Kissela BM, Kleindorfer DO. Temporal trends in stroke incidence over time by sex and age in the GCNKSS. Stroke. 2020; 51(4): 1070-1076. Erratum in: Stroke. 2020; 51(7): e141.
 
4.
Tracz J, Gorczyca-Głowacka I, Wałek P, Rosołowska A, Wożakowska-Kapłon B. Risk factors of ischaemic stroke in patients with atrial fibrillation. Med Stud. 2023; 39(1): 8-13.
 
5.
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258): 1204-1222. Erratum in: Lancet. 2020; 396(10262): 1562.
 
6.
GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258): 1223-1249.
 
7.
Garg R, Biller J. Recent advances in spontaneous intracerebral hemorrhage. F1000Res. 2019; 8: F1000 Faculty Rev-302.
 
8.
Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015; 46(7): 2032-2060.
 
9.
Shoamanesh A, Patrice Lindsay M, Castellucci LA, Cayley A, Crowther M, de Wit K, English SW, Hoosein S, Huynh T, Kelly M, O’Kelly CJ, Teitelbaum J, Yip S, Dowlatshahi D, Smith EE, Foley N, Pikula A, Mountain A, Gubitz G, Gioia LC. Canadian stroke best practice recommendations: management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020. Int J Stroke. 2021; 16(3): 321-341.
 
10.
Błażejewska-Hyżorek B, Czernuszenko A, Członkowska A, Ferens A, Gąsecki D, Kaczorowski R, Karaszewski B, Karliński M, Kaźmierski R, Kłysz B, Kobayashi A, Koze- ra G, Kozubski W, Krawczyk M, Kuczyńska A, Kurkowska- Jastrzębska I, Kwolek A, Luchowski P, Niewada M, Nowacki P, Nyka W, Opala G, Opara J, Poncyljusz W, Rej- dak K, Rożniecki J, Ryglewicz D, Sarzyńska-Długosz I, Seniów J, Skowrońska M, Sobolewski P, Staszewski J, Szczepańska-Szerej A, Szczudlik A, Wiszniewska M. Wytyczne postępowania w udarze mózgu. Pol Przegl Neurol. 2019; 15(supl. A): 30-92.
 
11.
Tracz J, Gorczyca-Głowacka I, Wełnicki M, Kołodziejska E, Rosołowska A, Mamcarz A, Wożakowska-Kapłon B. Ischaemic stroke in women and men – in-hospital prognosis. Med Stud. 2022; 38(1): 22-30.
 
12.
Kuramatsu JB, Gerner ST, Schellinger PD, Glahn J, End- res M, Sobesky J, Flechsenhar J, Neugebauer H, Jüttler E, Grau A, Palm F, Röther J, Michels P, Hamann GF, Hüwel J, Hagemann G, Barber B, Terborg C, Trostdorf F, Bäzner H, Roth A, Wöhrle J, Keller M, Schwarz M, Reimann G, Volkmann J, Müllges W, Kraft P, Classen J, Hobohm C, Horn M, Milewski A, Reichmann H, Schneider H, Schimmel E, Fink GR, Dohmen C, Stetefeld H, Witte O, Günther A, Neumann-Haefelin T, Racs AE, Nueckel M, Erbguth F, Kloska SP, Dörfler A, Köhrmann M, Schwab S, Huttner HB. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA. 2015; 313(8): 824-836.
 
13.
Li Q, Zhang G, Xiong X, Wang XC, Yang WS, Li KW, Wei X, Xie P. Black hole sign: novel imaging marker that predicts hematoma growth in patients with intracerebral hemorrhage. Stroke. 2016; 47(7): 1777-1781.
 
14.
Veltkamp R, Purrucker J. Management of spontaneous intracerebral hemorrhage. Curr Neurol Neurosci Rep. 2017; 17(10): 80.
 
15.
Roh DJ, Asonye IS, Carvalho Poyraz F, Magid-Bernstein JR, Joiner EF, Avadhani R, Awad I, Hanley DF, Ziai WC, Murthy SB. Intraventricular hemorrhage expansion in the CLEAR III trial: a post hoc exploratory analysis. Stroke. 2022; 53(6): 1847-1853.
 
16.
Chen Y, Chen S, Chang J, Perihematomal edema after intracerebral hemorrhage: an update on pathogenesis, risk factors, and therapeutic advances. Front Immunol. 2021; 12: 740632.
 
17.
Kozera G, Chwojnicki K, Gójska-Grymajło A, Gąsecki D, Schminke U, Nyka WM; Pomeranian Stroke Register collaborators. Pre-hospital delays and intravenous thrombolysis in urban and rural areas. Acta Neurol Scand. 2012; 126(3): 171-177.
 
18.
Szczuchniak W, Kozera G, Sobolewski P, Brola W, Staszewski J, Schminke U, Nyka WM; Pomeranian Stroke Registry collaborators. Length of stay in emergency department and cerebral intravenous thrombolysis in community hospitals. Eur J Emerg Med. 2017; 24(3): 208-216.
 
19.
Lyden P, Brott T, Tilley B, Welch KM, Mascha EJ, Levine S, Haley EC, Grotta J, Marler J. Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke. 1994; 25(11): 2220-2226.
 
20.
Bonita R, Beaglehole R. Recovery of motor function after Stroke. Stroke. 1988; 19: 1497-1500.
 
21.
Błażejewska-Hyżorek B, Czernuszenko A, Członkowska A, Drozdowski W, Gąsecki D, Kaźmierski R, Kobayashi A, Kozera G, Kozubski W, Krawczyk M, Kuczyńska-Zardzewiały A, Kwolek A, Niewada MP, Nowacki P, Opala G, Opara J, Rożniecki J, Sarzyńska-Długosz I, Seniów J, Skowrońska M, Słowik A, Sobolewski P, Staszewski J, Szczepańska-Szerej A, Szczudlik A, Wiszniewska M. Postępowanie w udarze mózgu: wytyczne Grupy Ekspertów Sekcji Chorób Naczyniowych Polskiego Towarzystwa Neurologicznego. Neurol Neurochir Pol. 2012; 46(1): 3-78.
 
22.
Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008. Cerebrovasc Dis 2008; 25: 457-507.
 
23.
Jin HQ, Wang JC, Sun YA, Lyu P, Cui W, Liu YY, Zhen ZG, Huang YN. Prehospital identification of stroke subtypes in Chinese rural areas. Chin Med J. (Engl) 2016; 129(9): 1041-1046.
 
24.
Wang DZ, Xue XD, Zhang H, Xu ZL, Zhang Y, Song GD, Wang C, Jiang GH. [The trend of intracerebral hemorrhage mortality of the residents with different characteristics in Tianjin, China, 1999-2015]. Zhonghua Yu Fang Yi Xue Za Zhi. 2018; 52(4): 389-395. Chinese.
 
25.
Otite FO, Akano EO, Akintoye E, Khandelwal P, Malik AM, Chaturvedi S, Rosand J. Rural-urban disparities in intracerebral hemorrhage mortality in the USA: preliminary findings from the national inpatient sample. Neurocrit Care. 2020; 32(3): 715-724.
 
26.
Daniel D, Santos D, Maillie L, Dhamoon MS. Variability in intensive care utilization for intracerebral hemorrhage in the United States: retrospective cohort study. J Stroke Cerebrovasc Dis. 2022; 31(8): 106619.
 
27.
Rodriguez-Luna D, Piñeiro S, Rubiera M, Ribo M, Coscojuela P, Pagola J, Flores A, Muchada M, Ibarra B, Meler P, Sanjuan E, Hernandez-Guillamon M, Alvarez-Sabin J, Montaner J, Molina CA. Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol. 2013; 20(9): 1277-1283.
 
28.
Ovenden CD, Hewitt J, Kovoor J, Gupta A, Edwards S, Abou-Hamden A, Kleinig T. Time to hospital presentation following intracerebral haemorrhage: proportion of patients presenting within eight hours and factors associated with delayed presentation. J Stroke Cerebrovasc Dis. 2022; 31(11): 106758.
 
29.
Morotti A, Li Q, Mazzoleni V, Schlunk F, Mazzacane F, Busto G, Scola E, Brancaleoni L, Giacomozzi S, Simonetti L, Laudisi M, Cavallini A, Zini A, Casetta I, Fainardi E, Dowlatshahi D, Padovani A, Arba F. Non-contrast CT markers of intracerebral hemorrhage expansion: the influence of onset-to-CT time. Int J Stroke. 2023; 18: 704-711.
 
30.
Al-Shahi Salman R, Frantzias J, Lee RJ, Lyden PD, Battey TWK, Ayres AM, Goldstein JN, Mayer SA, Steiner T, Wang X, Arima H, Hasegawa H, Oishi M, Godoy DA, Masotti L, Dowlatshahi D, Rodriguez-Luna D, Molina CA, Jang DK, Davalos A, Castillo J, Yao X, Claassen J, Volbers B, Kazui S, Okada Y, Fujimoto S, Toyoda K, Li Q, Khoury J, Delgado P, Sabín JÁ, Hernández-Guillamon M, Prats-Sánchez L, Cai C, Kate MP, McCourt R, Venkatasubramanian C, Diringer MN, Ikeda Y, Worthmann H, Ziai WC, d’Esterre CD, Aviv RI, Raab P, Murai Y, Zazulia AR, Butcher KS, Seyedsaadat SM, Grotta JC, Martí-Fàbregas J, Montaner J, Broderick J, Yamamoto H, Staykov D, Connolly ES, Selim M, Leira R, Moon BH, Demchuk AM, Di Napoli M, Fujii Y, Anderson CS, Rosand J; VISTA-ICH Collaboration; ICH Growth Individual Patient Data Meta-analysis Collaborators. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol. 2018; 17(10): 885-894. Erratum in: Lancet Neurol. 2018 Sep 19.
 
31.
Morotti A, Boulouis G, Charidimou A, Li Q, Poli L, Costa P, De Giuli V, Leuci E, Mazzacane F, Busto G, Arba F, Brancaleoni L, Giacomozzi S, Simonetti L, Laudisi M, Micieli G, Cavallini A, Candeloro E, Gamba M, Magoni M, War- ren AD, Anderson CD, Gurol ME, Biffi A, Viswanathan A, Casetta I, Fainardi E, Zini A, Pezzini A, Padovani A, Greenberg SM, Rosand J, Goldstein JN. Hematoma expansion in intracerebral hemorrhage with unclear onset. Neurology. 2021; 96(19): e2363-e2371.
 
32.
Belkic KL, Landsbergis PA, Schnall PL, Baker D. Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health. 2004; 30(2): 85-128.
 
33.
Kivimäki M, Jokela M, Nyberg ST, Singh-Manoux A, Fransson EI, Alfredsson L, Bjorner JB, Borritz M, Burr H, Casi- ni A, Clays E, De Bacquer D, Dragano N, Erbel R, Geu- skens GA, Hamer M, Hooftman WE, Houtman IL, Jöc- kel KH, Kittel F, Knutsson A, Koskenvuo M, Lunau T, Madsen IE, Nielsen ML, Nordin M, Oksanen T, Pejtersen JH, Pentti J, Rugulies R, Salo P, Shipley MJ, Siegrist J, Steptoe A, Suominen SB, Theorell T, Vahtera J, Westerholm PJ, Westerlund H, O’Reilly D, Kumari M, Batty GD, Ferrie JE, Virtanen M; IPD-Work Consortium. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015; 386(10005): 1739-1746.
 
34.
Eshak ES, Honjo K, Iso H, Ikeda A, Inoue M, Sawada N, Tsugane S. Changes in the employment status and risk of stroke and stroke types. Stroke. 2017; 48(5): 1176-1182.
 
35.
Toivanen S, Hemström O. Is the impact of job control on stroke independent from socioeconomic status?: A large-scale study of the Swedish working population. Stroke. 2008; 39(4): 1321-1323.
 
36.
Chen HS, Hsieh CF, Chau TT, Yang CD, Chen YW. Risk factors of in-hospital mortality of intracerebral hemorrhage and comparison of ICH scores in a Taiwanese population. Eur Neurol. 2011; 66(1): 59-63.
 
37.
Delcourt C, Zheng D, Chen X, Hackett M, Arima H, Hata J, Heeley E, Al-Shahi Salman R, Woodward M, Huang Y, Robinson T, Lavados PM, Lindley RI, Stapf C, Davies L, Chalmers J, Anderson CS, Sato S; INTERACT Investigators. Associations with health-related quality of life after intracerebral haemorrhage: pooled analysis of INTERACT studies. J Neurol Neurosurg Psychiatry. 2017; 88(1): 70-75.
 
38.
Kim JY, Bae HJ. Spontaneous intracerebral hemorrhage: management. J Stroke. 2017; 19(1): 28-39.
 
39.
Yan F, Yi Z, Hua Y, Shen Y, Li M, Ding Y, Chandra A, Ji X, Yue W. Predictors of mortality and recurrent stroke within five years of intracerebral hemorrhage. Neurol Res. 2018; 40(6): 466-472.
 
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