BACKGROUND AND OBJECTIVE: Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH. METHODS: We identified all patients admitted with spontaneous ICH to hospitals with a certified stroke unit in Brno, the second largest city in the Czech Republic (CR), in 2011, the year of the Czech Population and Housing Census. We reviewed their medical records for risk factors, radiographic parameters, and measures of post-stroke neurological deficit [National Institutes of Health Stroke Scale (NIHSS)]. Using the dates of death from the Czech National Mortality Register, we calculated mortality at 30 days, six months, one year, and three years after the ICH. Multivariate analysis with forward stepwise logistic regression was performed to determine independent predictors of mortality (p < 0.05). RESULTS: In 2011, 1086 patients with stroke were admitted to the four stroke-certified hospitals in Brno, CR. Of these, 134 had spontaneous ICH, with complete data available in 93 of them entering the final analysis. The mortality at 30 days, 6 months, 1 year, and 3 years post-ICH was 34%, 47%, 51%, and 63%, respectively. The mortality was highest in the first few days post-event, with 50% of patients dying in 255 days and average survival being 884 ± 90 days. Both NIHSS and modified ICH (MICH) score showed to be strong and reliable predictors of short- as well as long-term mortality; the risk of death post-ICH increased with older age and size of ICH. Other risk factors contributing to higher, primarily shorter-term mortality included history of cardiac failure, myocardial infarction, or atrial fibrillation. CONCLUSIONS: In our community-based study, we found that severity of neurological deficit at admission (NIHSS), combined with age and size of ICH, well predicted short- as well as long-term mortality after spontaneous ICH. A history of cardiac failure, myocardial infarction, or atrial fibrillation at presentation were also predictors of mortality, underscoring the need for optimal cardiac management in patients with ICH.

3rd Faculty of Medicine Charles University Prague Czech Republic

Clinic of Imaging Methods St Anne's University Hospital Brno Czech Republic

Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic

Department of Neurology Mayo Clinic Rochester MN USA

Faculty of Medicine Masaryk University Brno Czech Republic

Institute of Health Information and Statistics of the Czech Republic Prague Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Czech Republic

Neurological Clinic St Anne's University Hospital Brno Czech Republic

Neurological Clinic University Hospital Brno Brno Czech Republic

Neurosurgical Clinic Kralovske Vinohrady University Hospital Prague Czech Republic

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van Asch CJ, Luitse MJ, Rinkel GJ et al (2010) Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. https://doi.org/10.1016/S1474-4422(09)70340-0 PubMed DOI

Poon MTC, Fonville AF, Salman RAS (2014) Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. https://doi.org/10.1136/jnnp-2013-306476 PubMed DOI

Sedova P, Brown RD, Zvolsky M et al (2017) Incidence of hospitalized stroke in the Czech Republic: the national registry of hospitalized patients. J Stroke Cerebrovasc Dis. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.11.006 PubMed DOI

Sedova P, Brown RD, Zvolsky M et al (2021) Incidence of stroke and ischemic stroke subtypes: a community-based study in Brno, Czech Republic. Cerebrovasc Dis. https://doi.org/10.1159/000512180 PubMed DOI

Bryndziar T, Sedova P, Brown RD et al (2020) Trends in one month and one year hemorrhagic stroke case fatality rates in the Czech Republic between 1998 and 2015. J Stroke Cerebrovasc Dis. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104762 PubMed DOI

Bryndová L, Bar M, Herzig R et al (2021) Concentrating stroke care provision in the Czech Republic: the establishment of Stroke Centres in 2011 has led to improved outcomes. Health Policy. https://doi.org/10.1016/j.healthpol.2021.01.011 PubMed DOI PMC

Bryndziar T, Matyskova D, Sedova P et al (2022) Predictors of short- and long-term mortality in ischemic stroke: a community-based study in Brno, Czech Republic. Cerebrovasc Dis. https://doi.org/10.1159/000519937 PubMed DOI

Jackova J, Sedova P, Brown RD et al (2020) Risk factors in ischemic stroke subtypes: a community-based study in Brno, Czech Republic. J Stroke Cerebrovasc Dis. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104503 PubMed DOI

Broderick JP, Brott TG, Duldner JE et al (1993) Volume of intracerebral hemorrhage: A powerful and easy-to-use predictor of 30-day mortality. Stroke. https://doi.org/10.1161/01.STR.24.7.987 PubMed DOI

Gebel JM, Jauch EC, Brott TG et al (2002) Relative edema volume is a predictor of outcome in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke. https://doi.org/10.1161/01.STR.0000035283.34109.EA PubMed DOI

Nag C, Das K, Ghosh M, Khandakar MR (2012) Prediction of clinical outcome in acute hemorrhagic stroke from a single CT scan on admission. N Am J Med Sci. https://doi.org/10.4103/1947-2714.101986 PubMed DOI PMC

Hallevi H, Dar NS, Barreto AD et al (2009) The IVH Score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med. https://doi.org/10.1097/CCM.0b013e318198683a PubMed DOI PMC

Sreekrishnan A, Dearborn JL, Greer DM et al (2016) Intracerebral hemorrhage location and functional outcomes of patients: a systematic literature review and meta-analysis. Neurocrit Care. https://doi.org/10.1007/s12028-016-0276-4 PubMed DOI

Diringer MN, Edwards DF, Zazulia AR (1998) Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke. https://doi.org/10.1161/01.STR.29.7.1352 PubMed DOI

Witsch J, Neugebauer H, Zweckberger K, Jüttler E (2013) Primary cerebellar haemorrhage: complications, treatment and outcome. Clin Neurol Neurosurg 115(7):863–869 PubMed DOI

Cheung RTF, Zou LY (2003) Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage. Stroke. https://doi.org/10.1161/01.STR.0000078657.22835.B9 PubMed DOI

Satopää J, Mustanoja S, Meretoja A et al (2017) Comparison of all 19 published prognostic scores for intracerebral hemorrhage. J Neurol Sci. https://doi.org/10.1016/j.jns.2017.05.034 PubMed DOI

Cheung CM, Tsoi TH, Hon SFK et al (2008) Using the National Institutes of Health Stroke Scale (NIHSS) to predict the mortality and outcome of patients with intracerebral haemorrhage. Hong Kong Med J 14(5):367–370 PubMed

Finocchi C, Balestrino M, Malfatto L et al (2018) National Institutes of Health Stroke Scale in patients with primary intracerebral hemorrhage. Neurol Sci. https://doi.org/10.1007/s10072-018-3495-y PubMed DOI

Nilsson OG, Lindgren A, Brandt L, Säveland H (2002) Prediction of death in patients with primary intracerebral hemorrhage: a prospective study of a defined population. J Neurosurg. https://doi.org/10.3171/jns.2002.97.3.0531 PubMed DOI

Suo Y, Chen WQ, Pan YS et al (2018) The max-intracerebral hemorrhage score predicts long-term outcome of intracerebral hemorrhage. CNS Neurosci Ther 24:1149–1155. https://doi.org/10.1111/cns.12846 PubMed DOI PMC

Roquer J, Vivanco-Hidalgo RM, Prats-Sánchez LL et al (2019) Interaction of atrial fibrillation and antithrombotics on outcome in intracerebral hemorrhage. Neurology. https://doi.org/10.1212/WNL.0000000000008462 PubMed DOI PMC

Pana TA, Wood AD, Perdomo-Lampignano JA et al (2019) Impact of heart failure on stroke mortality and recurrence. Heart Asia. https://doi.org/10.1136/heartasia-2018-011139 PubMed DOI PMC

Zis P, Leivadeas P, Michas D et al (2014) Predicting 30-day case fatality of primary inoperable intracerebral hemorrhage based on findings at the emergency department. J Stroke Cerebrovasc Dis. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.02.006 PubMed DOI

Jolink WMT, Klijn CJM, Brouwers PJAM et al (2015) Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage. Neurology. https://doi.org/10.1212/WNL.0000000000002015 PubMed DOI

Weimar C, Benemann J, Diener HC (2006) Development and validation of the Essen intracerebral haemorrhage score. J Neurol Neurosurg Psychiatry. https://doi.org/10.1136/jnnp.2005.081117 PubMed DOI

Forti P, Maioli F, Domenico Spampinato M et al (2016) The effect of age on characteristics and mortality of intracerebral hemorrhage in the oldest-old. Cerebrovasc Dis. https://doi.org/10.1159/000448813 PubMed DOI

Delcourt C, Huang Y, Arima H et al (2012) Hematoma growth and outcomes in intracerebral hemorrhage: the INTERACT1 study. Neurology. https://doi.org/10.1212/WNL.0b013e318260cbba PubMed DOI

Fogelholm R, Murros K, Rissanen A, Avikainen S (2005) Long term survival after primary intracerebral haemorrhage: a retrospective population based study. J Neurol Neurosurg Psychiatry. https://doi.org/10.1136/jnnp.2004.055145 PubMed DOI PMC