J Neurol Neurosurg Psychiatry 85:660-667 doi:10.1136/jnnp-2013-306476
  • Cerebrovascular disease
  • Research paper

Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis

  1. Rustam Al-Shahi Salman3
  1. 1Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
  2. 2Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  3. 3Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor Rustam Al-Shahi Salman, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Bramwell Dott Building, Edinburgh EH4 2XU, UK; Rustam.Al-Shahi{at}
  • Received 4 August 2013
  • Revised 7 October 2013
  • Accepted 28 October 2013
  • Published Online First 21 November 2013


Background and aim There is uncertainty about the long-term prognosis after spontaneous intracerebral haemorrhage (ICH). Therefore, we systematically reviewed the literature for studies reporting long-term survival and ICH recurrence, and their predictors.

Methods We searched Ovid Medline 1946–2011 inclusive for cohort studies of ≥50 patients reporting long-term (>30 days) outcome after ICH. Two reviewers independently extracted data from each study. We meta-analysed 1-year and 5-year survival data from population-based studies using a random effects model (and quantified inconsistency using the I2 statistic).

Results We identified 122 eligible studies. The pooled estimate of 1-year survival was 46% (95% CI 43% to 49%; nine population-based studies (n=2408); I2=27%) and 5-year survival was 29% (95% CI 26% to 33%; three population-based studies (n=699); I2=6%). In 27 cohort studies, predictors most consistently associated with death were increasing age, decreasing Glasgow Coma Scale score, increasing ICH volume, presence of intraventricular haemorrhage, and deep/infratentorial ICH location. The annual risk of recurrent ICH varied from 1.3% to 7.4% in nine studies and this risk was higher after lobar ICH than non-lobar ICH in two of three hospital-based studies. Four studies reporting the risks of recurrent ICH and ischaemic stroke after ICH found no significant differences between these risks.

Conclusions Less than a half of patients with ICH survive 1 year and less than a third survive 5 years. Risks of recurrent ICH and ischaemic stroke after ICH appear similar after ICH, provoking uncertainties about the use of antithrombotic drugs.

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