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Cerebrovascular disease
Original research
Long-term functional decline of spontaneous intracerebral haemorrhage survivors
  1. Marco Pasi1,
  2. Barbara Casolla2,
  3. Maeva Kyheng3,
  4. Grégoire Boulouis4,
  5. Gregory Kuchcinski5,
  6. Solène Moulin6,
  7. Julien Labreuche7,
  8. Hilde Henon8,
  9. Didier Leys9,
  10. Charlotte Cordonnier1
  1. 1 Neurology, University of Lille, Lille, Hauts-de-France, France
  2. 2 Neurology. Stroke Unit, CHU Lille, Lille, Hauts-de-France, France
  3. 3 Medical Pharmacology, CHU Lille, Lille, Hauts-de-France, France
  4. 4 Neuroradiology, University Paris Descartes Faculty of Medicine Site Cochin, Paris, Île-de-France, France
  5. 5 Neuroradiology, Lille University Hospital Center, Lille, Hauts-de-France, France
  6. 6 Department of Neurology, University Hospital Centre Reims, Reims, Champagne-Ardenne, France
  7. 7 Statistical Department, CHU Lille, Lille, Hauts-de-France, France
  8. 8 Stroke Unit, CHU Lille, Lille, Hauts-de-France, France
  9. 9 Neurology, Stroke Unit, University of Lille, Lille, Hauts-de-France, France
  1. Correspondence to Professor Didier Leys, Neurology, Stroke Unit, University of Lille, Lille 59000, Hauts-de-France, France; didier.leys{at}univ-lille.fr

Abstract

Objective To identify in patients who survived 6 months after a spontaneous intracerebral haemorrhage (ICH) baseline characteristics and new clinical events associated with functional decline.

Methods In a single-centre study, we prospectively included 6-month survivors with a modified Rankin Scale (mRS) score 0–3. We defined functional decline by a transition to mRS 4–5. We evaluated associations of baseline characteristics and new clinical events with functional decline, using univariate and multivariable models.

Results Of 560 patients, 174 (31%) had an mRS score 0–3 at 6 months. During a median follow-up of 9 years (IQR 8.1–9.5), 40 (23%) converted to mRS 4–5. Age, diabetes mellitus, ICH volume and higher mRS scores at 6 months were independently associated with functional decline. Among baseline MRI markers, presence of strictly lobar cerebral microbleeds (CMBs), and mixed lobar and deep CMBs were independently associated with functional decline. When new clinical events occurring during follow-up were added in multivariable models, age (cause-specific HR (CSHR): 1.07; 95% CI: 1.03 to 1.11), ICH volume (CSHR: 1.03; 95% CI: 1.01 to 1.06), mRS score at 6 months (CSHR per 1 point increase 1.61, 95% CI 1.07 to 2.43), occurrence of dementia (CSHR: 3.81, 95% CI: 1.78 to 8.16) and occurrence of any stroke (CSHR: 4.29, 95% CI: 1.80 to 10.22) remained independently associated with transition to mRS 4–5.

Interpretation Almost one-fourth of patients with spontaneous ICH developed a functional decline over time. Age, ICH volume, higher mRS score at 6 months and new clinical events after ICH are the major determinants.

https://doi.org/10.1136/jnnp-2020-324741

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    Footnotes

    • Twitter @marco_pasi85, @BarbaraCasolla, @gboulouis, @leysdidier1

    • Contributors MP designed and conceptualised the study, analysed and interpreted all data and drafted the manuscript. BC and SM interpreted all data and revised the manuscript. MK and JL performed the statistical analyses. GB and GK contributed to data collection, analysed imaging data and revised the manuscript. HH conceptualised and designed the study, interpreted study data and revised the manuscript. DL and CC designed and conceptualised the study, analysed and interpreted all data, and drafted the manuscript.

    • Funding This study was funded by Inserm U1172 and Adrinord.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.