Intracerebral hemorrhage at young age: long-term prognosis

Background and purpose Intracerebral hemorrhage (ICH) is a devastating disorder associated with dismal outcomes. The long‐term mortality and functional outcome of ICH in young patients was studied – areas so far poorly investigated. Methods A follow‐up study was performed on a cohort of patients. Clinical and imaging data on ICH patients aged 16–49 were retrospectively obtained and linked with a nationwide cause‐of‐death register. The modified Rankin Scale (mRS) was evaluated for 30‐day survivors at a visit 9.7 (7.0–12.0) years after ICH onset. Independent factors associated with mortality and unfavorable functional outcome (mRS 2–5) were sought by multivariate analysis. Results Amongst the 268 1‐month survivors, 1‐year survival was 98.1% [95% confidence interval (CI) 96.2%–100%], 5‐year survival 93.2% (89.3%–97.1%) and 10‐year survival 88.8% (84.9%–92.7%). After adjustment for age and intraventricular hematoma extension, male sex [odds ratio (OR) 3.36, 95% CI 1.28–8.80] and diabetes (OR 2.64, 1.01–6.89) were associated with increased mortality. Unfavorable functional outcome emerged in 49%. After adjustment for confounders, age (OR 1.09 per 1 year, 95% CI 1.03–1.15), initial stroke severity (1.17 per one National Institutes of Health Stroke Scale score point, 1.08–1.27) and intraventricular hemorrhage (3.26, 1.11–9.55) were associated with unfavorable functional outcome. Conclusions Of every 10 survivors of acute phase ICH at a young age, one died within 10 years after onset, male sex and diabetes being associated with increased mortality. Half the survivors did not achieve a favorable functional outcome, which was predicted by increasing age, initial stroke severity and intraventricular hemorrhage. Click here for the corresponding questions to this CME article.