Dataset Information

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study.

ABSTRACT:

Background

Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP).

Methods

This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex.

Results

161 (4.4%) participants suffered an ICH episode. Mean age 87?±?9?years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127-174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p?=?0.02), hypercholesterolemia (55.3% vs. 47.4%, p?=?0.05), cardiovascular disease (36.6% vs. 28.9%; p?=?0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p?=?0.006). 93.2% had a HAS-BLED score???3. The independent risk factors for ICH were identified: HAS-BLED ?3 [OR 3.54; 95%CI 1.88-6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11-2.35], and cardiovascular disease [OR 1.48 IC95% 1.05-2.09]. The HAS_BLED ?3 score showed a high sensitivity [0.93 CI95% 0.89-0.97] and negative predictive value [0.98 (CI95% 0.83-1.12)].

Conclusions

In the CCP subgroup the incidence density of ICH was 5-60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH.

Trial registration

This study was retrospectively registered in ClinicalTrials.gov ( NCT03247049 ) on August 11/2017.

SUBMITTER: Lorman-Carbo B

PROVIDER: S-EPMC7863444 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study.

Lorman-Carbó Blanca B Clua-Espuny Josep Lluís JL Muria-Subirats Eulàlia E Ballesta-Ors Juan J González-Henares Maria Antònia MA Fernández-Sáez José J Martín-Luján Francisco M FM

BMC geriatrics 20210205 1

<h4>Background</h4>Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP).<h4>Methods</h4>This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/1 ...[more]

PMID: 33546615

Similar Datasets

Project description:Late seizures after intracerebral haemorrhage occur after the initial acute haemorrhagic insult subsides, and represent one of its most feared long-term sequelae. Both susceptibility to late seizures and their functional impact remain poorly characterized. We sought to: (i) compare patients with new-onset late seizures (i.e. delayed seizures), with those who experienced a recurrent late seizure following an immediately post-haemorrhagic seizure; and (ii) investigate the effect of late seizures on long-term functional performance after intracerebral haemorrhage. We performed prospective longitudinal follow-up of consecutive intracerebral haemorrhage survivors presenting to a single tertiary care centre. We tested for association with seizures the following neuroimaging and genetic markers of cerebral small vessel disease: APOE variants ?2/?4, computer tomography-defined white matter disease, magnetic resonance imaging-defined white matter hyperintensities volume and cerebral microbleeds. Cognitive performance was measured using the Modified Telephone Interview for Cognitive Status, and functional performance using structured questionnaires obtained every 6 months. We performed time-to-event analysis using separate Cox models for risk to develop delayed and recurrent seizures, as well as for functional decline risk (mortality, incident dementia, and loss of functional independence) after intracerebral haemorrhage. A total of 872 survivors of intracerebral haemorrhage were enrolled and followed for a median of 3.9 years. Early seizure developed in 86 patients, 42 of whom went on to experience recurrent seizures. Admission Glasgow Coma Scale, increasing haematoma volume and cortical involvement were associated with recurrent seizure risk (all P < 0.01). Recurrent seizures were not associated with long-term functional outcome (P = 0.67). Delayed seizures occurred in 37 patients, corresponding to an estimated incidence of 0.8% per year (95% confidence interval 0.5-1.2%). Factors associated with delayed seizures included cortical involvement on index haemorrhage (hazard ratio 1.63, P = 0.036), pre-haemorrhage dementia (hazard ratio 1.36, P = 0.044), history of multiple prior lobar haemorrhages (hazard ratio 2.50, P = 0.038), exclusively lobar microbleeds (hazard ratio 2.22, P = 0.008) and presence of ? 1 APOE ?4 copies (hazard ratio 1.95, P = 0.020). Delayed seizures were associated with worse long-term functional outcome (hazard ratio 1.83, P = 0.005), but the association was removed by adjusting for neuroimaging and genetic markers of cerebral small vessel disease. Delayed seizures after intracerebral haemorrhage are associated with different risk factors, when compared to recurrent seizures. They are also associated with worse functional outcome, but this finding appears to be related to underlying small vessel disease. Further investigations into the connections between small vessel disease and delayed seizures are warranted.

Project description:ObjectivesOverwork-related cerebrovascular and cardiovascular diseases (CCVDs) constitute a major occupational and public health issue worldwide. However, to our knowledge, few studies have reported the underlying pathophysiological mechanisms. We aimed to determine whether patients with extreme workload have a greater risk of developing hypertensive intracerebral haemorrhage (ICH) located in the deep brain areas than patients without extreme workload. We also determined the association between the number of hours of overtime work and the risk of developing hypertensive ICH.DesignUnmatched case-control study.SettingDatabase of patients claiming compensation for overwork-related CCVDs in Japan.ParticipantsA total of 1215 patients who claimed overwork-related ICH in Japan, of whom 621 had their compensation claim approved (patients with extreme workload) and 622 did not.Primary and secondary outcome measuresLogistic regression analysis was performed to calculate the risk of developing hypertensive ICH in patients with extreme workload compared with those without extreme workload, adjusted for confounders such as age, occupation, smoking status, alcohol consumption and medical history. We also calculated the risk of developing hypertensive ICH in compensated patients by average monthly overtime working hours.ResultsPatients with extreme workloads had a significantly higher odds ratio (OR) for developing hypertensive ICH (1.44, 95% CI: 1.10 to 1.88) than those without extreme workloads. ORs for developing hypertensive ICH according to overtime working hours showed a dose-response relationship; an overtime of 100 hours/month was associated with a significantly higher OR (1.31, 95% CI: 0.89 to 1.91; 1.41, 95% CI: 0.95 to 2.11; and 1.50, 95% CI: 1.01 to 2.22 for 60-79.9, 80-99.9 and≥100 hours/month, respectively) than that for workloads of less than 60 hours/month.ConclusionsRegarding Japanese workers, overtime work could be associated with the risk of developing hypertensive ICH, and hypertension may play an important role in overwork-related ICH.

Project description:IntroductionWhile the relationship between hypertension and incident intracerebral haemorrhage is well established, other risk factors are less clear. This study examined risk factors for primary intracerebral haemorrhage, separately for lobar and non-lobar intracerebral haemorrhage.Patients and methodsIncidence of intracerebral haemorrhage was studied among 28,416 individuals from the population-based Malmö Diet and Cancer cohort. Intracerebral haemorrhage cases were ascertained using the Swedish Hospital Discharge Register and the Stroke Register of Malmö, validated by review of hospital records and images, and classified by location by a neuroradiologist. Multivariable Cox regression was used.ResultsThree hundred and thirty-three intracerebral haemorrhages occurred, mean follow-up time was 18.4 years. Systolic blood pressure (hazard ratio per 10 mmHg 1.19 [95% confidence interval 1.13-1.26], diastolic blood pressure (hazard ratio 1.42 [1.27-1.59]), oral anticoagulants (hazard ratio 4.26 [2.17-8.38]), smoking (hazard ratio 1.45 [1.14-1.87]), living alone (hazard ratio 1.32 [1.04-1.69]) and low apolipoprotein B (hazard ratio per 10 mg/dL: 0.94 [0.90-0.99]) were significantly associated with incident intracerebral haemorrhage after multivariable adjustment. Systolic blood pressure, smoking and oral anticoagulants were associated with lobar intracerebral haemorrhage. Systolic blood pressure, diastolic blood pressure, living alone and diabetes were associated with non-lobar intracerebral haemorrhage. Diabetes and diastolic blood pressure showed significantly different relationships with lobar and non-lobar intracerebral haemorrhage. Alcohol, apolipoprotein A1, body mass index, waist circumference, physical activity and education were not independently associated with intracerebral haemorrhage.Discussion and conclusions: Blood pressure, smoking, low apolipoprotein B, oral anticoagulants and living alone were associated with intracerebral haemorrhage. Diabetes was associated with non-lobar intracerebral haemorrhage only. Further research is required on differences between lobar and non-lobar intracerebral haemorrhage.

Dataset Information

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study.

Background

Methods

Results

Conclusions

Trial registration

Publications

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets