Eur J Neurol. 2023 Jul 6. doi: 10.1111/ene.15968. Online ahead of print.

ABSTRACT

BACKGROUND: Several risk factors of symptomatic intracerebral hemorrhage (SICH) following intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) have been established. However, potential predictors of good functional outcome post-SICH have been less studied.

METHODS: Patient-data registered in Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) during 2005 and 2021 were used. AIS-patients who developed post-IVT SICH according to SITS-Monitoring Study definition were analyzed to identify predictors of functional outcomes.

RESULTS: A total of 1,679 patients with reported SICH were included, out of which only 2.8% achieved good functional outcome [modified Rankin Scale (mRS) scores of 0-2], while 80.9% died at 3 months. Higher baseline-NIHSS and 24-hour-ΔNIHSS scores were independently associated with lower likelihood of achieving both good and excellent functional outcomes at 3 months. Baseline-NIHSS and hematoma location (presence of both-SICH, defined as remote- and local-SICH concurrently; n=478) were predictors of early mortality within 24 hours. Independent predictors of 3-month mortality were age, baseline-NIHSS, 24-hour-ΔNIHSS, admission serum glucose values, and hematoma location (both-SICH). Age, baseline-NIHSS-score, 24-hour-ΔNIHSS, hyperlipidemia, prior stroke/TIA, antiplatelet treatment, diastolic blood pressure at admission, glucose values on admission and SICH location (both-SICH) were associated with reduced disability at 3 months (≥1-point reduction across all mRS scores). Patients with remote-SICH (n=219) and local-SICH (n=964) had comparable clinical outcomes, both before and after propensity-score-matching.

CONCLUSIONS: SICH presents an alarmingly high prevalence of adverse clinical outcomes, with no difference in clinical outcomes between remote- and local-SICH.

PMID:37410547 | DOI:10.1111/ene.15968