Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study
Introduction Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (I...
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| Veröffentlicht in: | Advances in therapy 2020-02, Vol.37 (2), p.833-846 |
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| creator | González-Henares, Maria Antonia Clua-Espuny, Jose Luis Lorman-Carbo, Blanca Fernández-Saez, Jose Queralt-Tomas, Lluisa Muria-Subirats, Eulalia Ballesta-Ors, Juan Gil-Guillen, Jose Vicente |
| description | Introduction
Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings.
Methods
This was a multicenter and retrospective study (April 1, 2006–December 31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan–Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January 1, 2013–December 31, 2017) of the population of complex chronic patients with an episode of ICH.
Results
A total of 3594 people aged ≥ 65 years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4 years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013–December 31, 2017). The primary outcome was death from any cause within 5 years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80 years (HR 1.048, 95% CI 1.021–1.076,
p
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| doi_str_mv | 10.1007/s12325-019-01206-y |
| format | Article |
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Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings.
Methods
This was a multicenter and retrospective study (April 1, 2006–December 31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan–Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January 1, 2013–December 31, 2017) of the population of complex chronic patients with an episode of ICH.
Results
A total of 3594 people aged ≥ 65 years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4 years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013–December 31, 2017). The primary outcome was death from any cause within 5 years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80 years (HR 1.048, 95% CI 1.021–1.076,
p
< 0.001) and HAS-BLED score (HR 1.369, 95% CI 1.057–1.774,
p
= 0.017). Compared to the general population, the incidence density/1000 person per year (15 vs 0.22) was significantly higher with a significantly lower annual lethality rate (17% vs 49.2%); and both the prognostic factors and the risk of stratified mortality showed different epidemiological patterns. The internal validation of the model was optimal (log-rank < 0.0001) in the general population, but its external validation was not significant in the complex chronic patient population (log-rank
p
= 0.104).
Conclusions
The ICH-AP is a clinical scale that can improve the prognostic prediction of mortality in primary care after an episode of ICH in the general population, but it was not significant in its external validation in a population of complex chronic patients.
Trial Registration
ClinicalTrials.gov ID: NCT03247049.</description><identifier>ISSN: 0741-238X</identifier><identifier>EISSN: 1865-8652</identifier><identifier>DOI: 10.1007/s12325-019-01206-y</identifier><identifier>PMID: 31879838</identifier><language>eng</language><publisher>Cheshire: Springer Healthcare</publisher><subject>Cardiology ; Endocrinology ; Health technology assessment ; Internal Medicine ; Medicine ; Medicine & Public Health ; NCT ; NCT03247049 ; Oncology ; Original Research ; Pharmacology/Toxicology ; Rheumatology</subject><ispartof>Advances in therapy, 2020-02, Vol.37 (2), p.833-846</ispartof><rights>Springer Healthcare Ltd., part of Springer Nature 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-159214854eef1b03e60188a124550a84811216f972bb3da6cb54654081233b633</citedby><cites>FETCH-LOGICAL-c347t-159214854eef1b03e60188a124550a84811216f972bb3da6cb54654081233b633</cites><orcidid>0000-0002-6508-5741</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12325-019-01206-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12325-019-01206-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31879838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>González-Henares, Maria Antonia</creatorcontrib><creatorcontrib>Clua-Espuny, Jose Luis</creatorcontrib><creatorcontrib>Lorman-Carbo, Blanca</creatorcontrib><creatorcontrib>Fernández-Saez, Jose</creatorcontrib><creatorcontrib>Queralt-Tomas, Lluisa</creatorcontrib><creatorcontrib>Muria-Subirats, Eulalia</creatorcontrib><creatorcontrib>Ballesta-Ors, Juan</creatorcontrib><creatorcontrib>Gil-Guillen, Jose Vicente</creatorcontrib><title>Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study</title><title>Advances in therapy</title><addtitle>Adv Ther</addtitle><addtitle>Adv Ther</addtitle><description>Introduction
Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings.
Methods
This was a multicenter and retrospective study (April 1, 2006–December 31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan–Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January 1, 2013–December 31, 2017) of the population of complex chronic patients with an episode of ICH.
Results
A total of 3594 people aged ≥ 65 years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4 years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013–December 31, 2017). The primary outcome was death from any cause within 5 years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80 years (HR 1.048, 95% CI 1.021–1.076,
p
< 0.001) and HAS-BLED score (HR 1.369, 95% CI 1.057–1.774,
p
= 0.017). Compared to the general population, the incidence density/1000 person per year (15 vs 0.22) was significantly higher with a significantly lower annual lethality rate (17% vs 49.2%); and both the prognostic factors and the risk of stratified mortality showed different epidemiological patterns. The internal validation of the model was optimal (log-rank < 0.0001) in the general population, but its external validation was not significant in the complex chronic patient population (log-rank
p
= 0.104).
Conclusions
The ICH-AP is a clinical scale that can improve the prognostic prediction of mortality in primary care after an episode of ICH in the general population, but it was not significant in its external validation in a population of complex chronic patients.
Trial Registration
ClinicalTrials.gov ID: NCT03247049.</description><subject>Cardiology</subject><subject>Endocrinology</subject><subject>Health technology assessment</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>NCT</subject><subject>NCT03247049</subject><subject>Oncology</subject><subject>Original Research</subject><subject>Pharmacology/Toxicology</subject><subject>Rheumatology</subject><issn>0741-238X</issn><issn>1865-8652</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kUFv1DAQhS0EokvhD3BAPnIxeOw48XIrEdBKi1pBkbhZTnaym5LE27ED5BfwtzHdwpHD0xzme-_wHmPPQb4CKavXEZRWRkhYZylZiuUBW4EtjchSD9lKVgUIpe3XE_YkxhsplayMfcxONNhqbbVdsV-f-viNh45vwrQT10gj_xgo-aFPC-8C8TqMhwF_8npPYepbfuVTj1OK_Eef9vxiSuRbJGzID_wcx0C09zt8w8_4VTjMQ6bDJN76iFuOog77HM4vm4j0_e6VXZ_TvF2eskedHyI-u7-n7Mv7d9f1udhcfriozzai1UWVBJi1gsKaArGDRmosJVjrQRXGSG8LC6Cg7NaVahq99WXbmKI0hbS5Kt2UWp-yl8fcA4XbGWNyYx9bHAY_YZijyxgoY6VSGVVHtKUQI2HnDtSPnhYH0v0ZwB0HcHkAdzeAW7LpxX3-3Iy4_Wf523gG9BGI-TXtkNxNmCn3EP8X-xtDSJGU</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>González-Henares, Maria Antonia</creator><creator>Clua-Espuny, Jose Luis</creator><creator>Lorman-Carbo, Blanca</creator><creator>Fernández-Saez, Jose</creator><creator>Queralt-Tomas, Lluisa</creator><creator>Muria-Subirats, Eulalia</creator><creator>Ballesta-Ors, Juan</creator><creator>Gil-Guillen, Jose Vicente</creator><general>Springer Healthcare</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6508-5741</orcidid></search><sort><creationdate>20200201</creationdate><title>Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study</title><author>González-Henares, Maria Antonia ; Clua-Espuny, Jose Luis ; Lorman-Carbo, Blanca ; Fernández-Saez, Jose ; Queralt-Tomas, Lluisa ; Muria-Subirats, Eulalia ; Ballesta-Ors, Juan ; Gil-Guillen, Jose Vicente</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-159214854eef1b03e60188a124550a84811216f972bb3da6cb54654081233b633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cardiology</topic><topic>Endocrinology</topic><topic>Health technology assessment</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>NCT</topic><topic>NCT03247049</topic><topic>Oncology</topic><topic>Original Research</topic><topic>Pharmacology/Toxicology</topic><topic>Rheumatology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>González-Henares, Maria Antonia</creatorcontrib><creatorcontrib>Clua-Espuny, Jose Luis</creatorcontrib><creatorcontrib>Lorman-Carbo, Blanca</creatorcontrib><creatorcontrib>Fernández-Saez, Jose</creatorcontrib><creatorcontrib>Queralt-Tomas, Lluisa</creatorcontrib><creatorcontrib>Muria-Subirats, Eulalia</creatorcontrib><creatorcontrib>Ballesta-Ors, Juan</creatorcontrib><creatorcontrib>Gil-Guillen, Jose Vicente</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Advances in therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>González-Henares, Maria Antonia</au><au>Clua-Espuny, Jose Luis</au><au>Lorman-Carbo, Blanca</au><au>Fernández-Saez, Jose</au><au>Queralt-Tomas, Lluisa</au><au>Muria-Subirats, Eulalia</au><au>Ballesta-Ors, Juan</au><au>Gil-Guillen, Jose Vicente</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study</atitle><jtitle>Advances in therapy</jtitle><stitle>Adv Ther</stitle><addtitle>Adv Ther</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>37</volume><issue>2</issue><spage>833</spage><epage>846</epage><pages>833-846</pages><issn>0741-238X</issn><eissn>1865-8652</eissn><abstract>Introduction
Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings.
Methods
This was a multicenter and retrospective study (April 1, 2006–December 31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan–Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January 1, 2013–December 31, 2017) of the population of complex chronic patients with an episode of ICH.
Results
A total of 3594 people aged ≥ 65 years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4 years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013–December 31, 2017). The primary outcome was death from any cause within 5 years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80 years (HR 1.048, 95% CI 1.021–1.076,
p
< 0.001) and HAS-BLED score (HR 1.369, 95% CI 1.057–1.774,
p
= 0.017). Compared to the general population, the incidence density/1000 person per year (15 vs 0.22) was significantly higher with a significantly lower annual lethality rate (17% vs 49.2%); and both the prognostic factors and the risk of stratified mortality showed different epidemiological patterns. The internal validation of the model was optimal (log-rank < 0.0001) in the general population, but its external validation was not significant in the complex chronic patient population (log-rank
p
= 0.104).
Conclusions
The ICH-AP is a clinical scale that can improve the prognostic prediction of mortality in primary care after an episode of ICH in the general population, but it was not significant in its external validation in a population of complex chronic patients.
Trial Registration
ClinicalTrials.gov ID: NCT03247049.</abstract><cop>Cheshire</cop><pub>Springer Healthcare</pub><pmid>31879838</pmid><doi>10.1007/s12325-019-01206-y</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-6508-5741</orcidid></addata></record> |
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| subjects | Cardiology Endocrinology Health technology assessment Internal Medicine Medicine Medicine & Public Health NCT NCT03247049 Oncology Original Research Pharmacology/Toxicology Rheumatology |
| title | Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study |
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