Scientists have found new ways that intracerebral hemorrhages or an ICH stroke can affect patients’ health.

A new study headed by University of Cincinnati researchers sheds new light on how different risk factors can alter patient outcomes after one of the most severe types of stroke.

Intracerebral hemorrhages (ICH) occur when a blood vessel inside the brain bursts, causing bleeding in the brain, according to Daniel Woo, MD. ICH strokes are generally fatal and result in significant neurological impairment.

Several different factors have been found to be associated with a higher chance of disability or death following an ICH stroke up to this point, but Woo believes more precise data is needed.

Woo led a cohort study three months after an ICH episode, assessing outcome data from one of the largest-ever prospectively recruited groups of patients, which included 1,000 non-Hispanic white, 1,000 non-Hispanic Black, and 1,000 Hispanic patients. The study’s findings were just published in JAMA.

Findings

Two previously defined clinical grading measures were one of the methods utilized by researchers to identify risk variables.

Both grading scales, according to Woo, are simple to calculate and use multiple characteristics to assign a point value to the patient, including age, hemorrhage size, location, and severity, with one of the ratings also evaluating whether the patient had cognitive impairment prior to the hemorrhage. The scales are designed to associate a greater point value with a prediction of higher death rates.

According to Woo, high scores on both scales were validated for the first time in Black and Hispanic populations to be connected with greater mortality rates after previously being verified in a mostly white patient dataset. For all patient ethnicities, each individual component that makes up each score, as well as particular markers discovered on brain scans, were found to be related to bad outcomes.

“Scores like these are easy to learn and to apply but they obviously don’t capture the wide variation among patients,” adds Woo. “For me, adding in a few baseline variables from the CT scan at admission would greatly enhance these scores.”

Although grading schemes are effective for comparing large groups of patients and predicting outcomes, Woo believes that clinicians should utilize more than simply the ratings to predict outcomes and guide care decisions. To get a more complete picture, the researchers looked at 76 different risk factors to see if they were linked to good or bad patient outcomes.

A previous history of ischemic stroke, in which a vessel carrying blood to the brain is occluded, or atrial fibrillation, an abnormal heart rhythm, substantially quadrupled the risk of major impairment or death, according to the researchers.

The researchers discovered that while larger hemorrhages were linked to a higher risk of death, Black and Hispanic patients were much more likely to die than white patients with equal hemorrhage sizes. According to Woo, more research is needed to determine the cause of the difference.

Clinical applications

Some of the most intriguing findings from the study, according to Woo, were the effects of events that occurred after patients were 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.

Infections acquired during a hospital stay were found to increase the risk of major disability or death by more than three times. Patients with a hematoma, or a collection of blood within the brain, that grew throughout their hospital stay had a 1.6 times higher chance of having bad outcomes.

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

With a greater understanding of the relationship between these characteristics and outcomes, Woo believes clinicians can use the information from this study to make better judgments 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 adds. “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.”

Source: 10.1001/jamanetworkopen.2022.1103

Image Credit: Getty

You were reading: Signs you are at greater risk of disability and death following a stroke – study