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November 17, 2020; 95 (20) Article

Cause of death in spontaneous intracerebral hemorrhage survivors

Multistate longitudinal study

View ORCID ProfileLindsey R. Kuohn, View ORCID ProfileAudrey C. Leasure, Julian N. Acosta, Kevin Vanent, Santosh B. Murthy, Hooman Kamel, View ORCID ProfileCharles C. Matouk, Lauren H. Sansing, View ORCID ProfileGuido J. Falcone, View ORCID ProfileKevin N. Sheth
First published September 11, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010736
Lindsey R. Kuohn
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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Audrey C. Leasure
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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Julian N. Acosta
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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Kevin Vanent
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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Santosh B. Murthy
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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Hooman Kamel
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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Charles C. Matouk
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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Lauren H. Sansing
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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Guido J. Falcone
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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  • ORCID record for Guido J. Falcone
Kevin N. Sheth
From the Divisions of Neurocritical Care and Emergency Neurology (L.R.K., A.C.L., J.N.A., K.V., G.J.F., K.N.S.) and Stroke and Vascular Neurology (L.H.S.), Department of Neurology, and Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; and Clinical and Translational Neuroscience Unit (S.B.M., H.K.), Department of Neurology, Weill Cornell Medicine, New York, NY.
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  • ORCID record for Kevin N. Sheth
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Citation
Cause of death in spontaneous intracerebral hemorrhage survivors
Multistate longitudinal study
Lindsey R. Kuohn, Audrey C. Leasure, Julian N. Acosta, Kevin Vanent, Santosh B. Murthy, Hooman Kamel, Charles C. Matouk, Lauren H. Sansing, Guido J. Falcone, Kevin N. Sheth
Neurology Nov 2020, 95 (20) e2736-e2745; DOI: 10.1212/WNL.0000000000010736

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Abstract

Objective To determine the leading causes of death in intracerebral hemorrhage (ICH) survivors, we used administrative data from 3 large US states to identify adult survivors of a first-time spontaneous ICH and track all hospital readmissions resulting in death.

Methods We performed a longitudinal analysis of prospectively collected claims data from hospitalizations in California (2005–2011), New York (2005–2014), and Florida (2005–2014). Adult residents admitted with a nontraumatic ICH who survived to discharge were included. Patients were followed for a primary outcome of any readmission resulting in death. The cause of death was defined as the primary diagnosis assigned at discharge. Multivariable Cox proportional hazards and multinomial logistic regression were used to determine factors associated with the risk for and cause of death.

Results Of 72,432 ICH survivors (mean age 68 years [SD 16], 48% female), 12,753 (18%) died during a median follow-up period of 4.0 years (interquartile range 2.3–6.3). The leading causes of death were infection (34%), recurrent intracranial hemorrhage (14%), cardiac disease (8%), respiratory failure (8%), and ischemic stroke (5%). Death in patients with atrial fibrillation (AF) was more likely to be caused by ischemic stroke (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.9–2.9, p < 0.001) and less likely to be caused by recurrent intracranial hemorrhage (OR 0.7, 95% CI 0.6–0.8, p < 0.001) compared to patients without AF.

Conclusions Infection is the leading cause of death in all ICH survivors. Survivors with AF were at increased risk for death from ischemic stroke. These findings will help prioritize interventions aimed to improve long-term survival and recovery in ICH survivors.

Glossary

AF=
atrial fibrillation;
CHF=
congestive heart failure;
CI=
confidence interval;
HR=
hazard ratio;
ICD-9-CM=
International Classification of Diseases, 9th revision, Clinical Modification;
ICH=
intracerebral hemorrhage;
IQR=
interquartile range;
MI=
myocardial infarction

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Received February 12, 2020.
  • Accepted in final form June 18, 2020.
  • © 2020 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Author response: Cause of death in spontaneous intracerebral hemorrhage survivors
    • Lindsey Kuohn, Medical Student, NYU Grossman School of Medicine
    • Kevin Sheth, Neurologist, Yale School of Medicine
    Submitted December 15, 2020
  • Reader response: Cause of death in spontaneous intracerebral hemorrhage survivors Multistate longitudinal study
    • Andres E Llamas-Nieves, Researcher, Medical-Surgical Research Center, University of Cartagena, Colombia
    • Ivan D Lozada-Martinez, Researcher, Medical-Surgical Research Center, University of Cartagena, Colombia
    • Daniela M Torres-Llinás, Researcher, Medical-Surgical Research Center, University of Cartagena, Colombia
    • Luis R Moscote-Salazar, Neurosurgeon - Critical Care, Medical-Surgical Research Center, University of Cartagena, Colombia
    Submitted December 06, 2020
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