Identifying risk factors following ICH strokes
New research shows correlations that lead to worse patient outcomes

Date:
March 28, 2022
Source:
University of Cincinnati
Summary:
Researchers reveal new insights into how different risk factors
following intracerebral hemorrhages can affect patient outcomes.



FULL STORY ==========================================================================
A new study led by University of Cincinnati researchers provides new
insights on how different risk factors following one of the most severe
types of stroke can affect patient outcomes.


========================================================================== Daniel Woo, MD, said intracerebral hemorrhages (ICH) are caused when a
blood vessel bursts inside the brain and causes bleeding in the brain. ICH strokes are often deadly and can cause high neurological disability.

Up to this point, many different factors have been generally reported to
be associated with a higher likelihood of disability or death following
an ICH stroke, but Woo said there was a need for more specific data.

To learn more, Woo led a cohort study analyzing outcome data three
months after an ICH event from one of the largest-ever prospectively
recruited group of patients, which included 1,000 non-Hispanic white,
1,000 non-Hispanic Black and 1,000 Hispanic patients. The results of
the study were recently published in JAMA.

New insights One of the avenues researchers used to assess risk factors
were two clinical grading scales that have been previously developed.



==========================================================================
Woo said both grading scales are easy to calculate and take several
variables like age and hemorrhage size, location and severity to assign
a point value to the patient, with one of the scales additionally
considering whether a patient had cognitive impairment before the
hemorrhage. A higher point value using the scales is designed to correlate
with a prediction of higher death rates.

In this study, Woo said high scores on both scales were confirmed for the
first time to be correlated with increased mortality rates in Black and Hispanic populations after previously being verified in a predominantly
white patient dataset. Each individual variable that makes up each score,
as well as certain markers found on brain scans, were also found to be associated with poor outcomes for all patient ethnicities.

"Scores like these are easy to learn and to apply but they obviously
don't capture the wide variation among patients," said Woo, vice chair
of research in UC's Department of Neurology and a UC Health physician at
the UC Gardner Neuroscience Institute. "For me, adding in a few baseline variables from the CT scan at admission would greatly enhance these
scores." Although the grading scales are useful to compare large numbers
of patients to predict outcomes, Woo said physicians should use more
than just the scores to predict outcomes and guide care decisions. The researchers analyzed a total of 76 separate risk factors for association
with good or poor results for patients to provide a fuller picture.

The researchers found that a previous history of ischemic stroke,
when a vessel supplying blood to the brain is obstructed, or atrial fibrillation, an irregular heart rhythm, nearly doubled the likelihood
of serious disability or death.



==========================================================================
The study found that larger hemorrhages were correlated with a greater likelihood of death, but Black and Hispanic patients were even more
likely to die than white patients with similar hemorrhage sizes. Woo said further study needs to be conducted to find the reason for this disparity.

Clinical applications Woo said some of the most fascinating results
from the study were the effect of events that occurred after patients
had been admitted to the hospital.

"Most previous findings were reported based on when the patient first
reached the hospital, but we found that many complications occurring
during the hospitalization had a marked impact on outcomes," he said.

Researchers found patients who developed infections during a hospital
stay were more than three times more likely for serious disability or
death. Patients whose hematoma, or collection of blood within the brain, expanded during their hospital stay were 1.6 times more likely to have
poor results.

"These had very strong effects and may be things that we can intervene
on to improve outcomes," Woo said.

With the correlation between these variables and outcomes now better understood, Woo said physicians can take the knowledge from this study
to make more informed decisions when caring for individual patients.

"Our research provides a wide variety of past history, signs and
subsequent events that can affect outcomes after ICH that clinicians
can now incorporate into their assessment," he said. "It also provides
the relative strength of each variable which they can incorporate into
their assessments. In addition, many of these may be targets we can
design treatments for through research to improve outcomes in the future."

========================================================================== Story Source: Materials provided by University_of_Cincinnati. Original
written by Tim Tedeschi. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Daniel Woo, Mary E. Comeau, Simone Uniken Venema, Christopher D.

Anderson, Matthew Flaherty, Fernando Testai, Steven Kittner,
Michael Frankel, Michael L. James, Gene Sung, Mitchell Elkind,
Bradford Worrall, Chelsea Kidwell, Nicole Gonzales, Sebastian
Koch, Christiana Hall, Lee Birnbaum, Douglas Mayson, Bruce Coull,
Marc Malkoff, Kevin N. Sheth, Jacob L. McCauley, Jennifer Osborne,
Misty Morgan, Lee Gilkerson, Tyler Behymer, Elisheva R. Coleman,
Jonathan Rosand, Padmini Sekar, Charles J.

Moomaw, Carl D. Langefeld. Risk Factors Associated With Mortality
and Neurologic Disability After Intracerebral Hemorrhage in a
Racially and Ethnically Diverse Cohort. JAMA Network Open, 2022;
5 (3): e221103 DOI: 10.1001/jamanetworkopen.2022.1103 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/03/220328121359.htm

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