PT  - JOURNAL ARTICLE
AU  - Michael Tin Chung Poon
AU  - Arthur François Fonville
AU  - Rustam Al-Shahi Salman
TI  - Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis
AID  - 10.1136/jnnp-2013-306476
DP  - 2014 Jun 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 660--667
VI  - 85
IP  - 6
4099  - http://jnnp.bmj.com/content/85/6/660.short
4100  - http://jnnp.bmj.com/content/85/6/660.full
SO  - J Neurol Neurosurg Psychiatry2014 Jun 01; 85
AB  - 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.