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Open Access

In-hospital complications affect short-term and long-term mortality in ICH: a prospective cohort study

Yaqing Zhang, Yongjun Wang, Ruijun Ji, Anxin Wang, Yilong Wang, Zhonghua Yang, Liping Liu, Penglian Wang, Xingquan Zhao
DOI: 10.1136/svn-2020-000386 Published 28 June 2021
Yaqing Zhang
1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yongjun Wang
1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2 China National Clinical Research Center for Neurological Diseases, Beijing, China
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Ruijun Ji
1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Anxin Wang
2 China National Clinical Research Center for Neurological Diseases, Beijing, China
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Yilong Wang
1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
3 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Zhonghua Yang
1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Liping Liu
1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
4 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Penglian Wang
1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Xingquan Zhao
1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2 China National Clinical Research Center for Neurological Diseases, Beijing, China
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    Figure 1

    Flow diagram of the study population.

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  • Table 1

    Baseline clinical characteristics and outcomes of the study patients with intracerebral haemorrhage

    VariableTotal (n=3255)With any medical complications (n=878)Without medical complications (n=2377)P value
    Age, mean±SD (years)62±1366±1361±13<0.0001
    Age ≥65 years, n (%)1414 (43.44)499 (56.83)915 (38.49)<0.0001
    Gender, female, n (%)1260 (38.71)352 (40.09)908 (38.20)0.3254
    Hypertension, n (%)2191 (67.31)593 (67.54)1598 (67.23)0.8661
    Hyperlipidaemia, n (%)230 (7.07)56 (6.38)174 (7.32)0.3519
    Diabetes mellitus, n (%)285 (8.76)88 (10.02)197 (8.29)0.1201
    History of stroke, n (%)889 (27.31)272 (30.98)617 (25.96)0.0043
    History of TIA, n (%)29 (0.89)10 (1.14)19 (0.80)0.3601
    History of AF, n (%)54 (1.66)20 (2.2834 (1.43)0.0929
    History of coronary heart disease (CHD), n (%)204 (6.27)65 (7.40)139 (5.85)0.1042
    Family history of stroke, n (%)491 (15.08)119 (13.55)372 (15.65)0.138
    Medical history, n (%)
     Antihypertension treatment1910 (58.68)566 (64.46)1344 (56.54)<0.0001
     Antiplatelet treatment31 (0.95)8 (0.91)23 (0.97)0.883
     Anticoagulant treatment24 (0.74)9 (1.03)15 (0.63)0.2435
     Hypoglycaemic treatment405 (12.44)152 (17.31)253 (10.64)<0.0001
     Lipid-lowering treatment275 (8.45)57 (6.49)218 (9.17)0.0147
    Current smoking, n (%)825 (25.35)208 (23.69)617 (25.96)0.187
    Current heavy drinking, n (%)998 (30.66)243 (27.68)755 (31.76)0.0248
    Baseline NIHSS, median (IQR)10.0 (4.0–18.0)16 (9.0–25.0)8 (3.0–14.00)<0.0001
    GCS at admission, median (IQR)14.0 (9.0–15.0)10 (6.0–15.0)15 (11–15.0)<0.0001
    Haematoma volume, median (IQR)12.6 (5.5–28.0)18.64 (7.5–41.8)11.76 (4.8–24.0)<0.0001
    Haematoma location, n (%)
     Basal ganglia1878 (57.7)492 (56.04)1386 (58.31)0.2442
     Lobar704 (21.63)215 (24.49)489 (20.57)0.016
     Thalamus631 (19.39)178 (20.27)453 (19.06)0.4362
     Brainstem258 (7.93)95 (10.82)163 (6.86)0.0002
     Cerebellum184 (5.65)57 (6.49)127 (5.34)0.2077
    Death during hospitalisation, n (%)297 (9.12)184 (20.96)113 (4.75)<0.0001
    Death at 3 months, n (%)650 (19.97)337 (38.38)313 (13.17)<0.0001
    Death at 6 months, n (%)732 (22.49)361 (41.12)371 (15.61)<0.0001
    Death at 12 months, n (%)850 (26.11)396 (45.10)454 (19.10)<0.0001
    • AF, atrial fibrillation; GCS, Glasgow Coma Scale; NIHSS, National Institutes of Health Stroke Scale; TIA, transient ischaemic attack.

  • Table 2

    Unadjusted and adjusted ORs for medical complications in relation to the mortality of patients with ICH during hospitalisation, and at 3 months, 6 months and 1 year

    VariableUnadjusted OR (95% CI)Adjusted OR (95% CI)*
    Pneumonia (Yes vs No)
     During hospitalisation2.41 (1.86 to 3.13)2.23 (1.59 to 3.13)
     At 3 months2.59 (2.12 to 3.16)1.52 (1.15 to 2.00)
     At 6 months2.56 (2.12 to 3.11)1.40 (1.07 to 1.82)
     At 12 months2.42 (2.00 to 2.91)1.19 (0.92 to 1.55)
    Pulmonary embolism (Yes vs No)
     During hospitalisation3.77 (0.99 to 14.27)2.39 (0.39 to 14.68)
     At 3 months1.51 (0.40 to 5.69)0.82 (0.12 to 5.73)
     At 6 months2.89 (0.88 to 9.48)1.47 (0.27 to 8.00)
     At 12 months3.41 (1.04 to 11.21)2.19 (0.43 to 11.05)
    Deep vein thrombosis (Yes vs No)
     During hospitalisation0.47 (0.06 to 3.52)0.84 (0.10 to 6.88)
     At 3 months0.89 (0.30 to 2.64)0.92 (0.23 to 3.66)
     At 6 months1.01 (0.37 to 2.76)1.09 (0.31 to 3.85)
     At 12 months1.97 (0.84 to 4.63)1.64 (0.52 to 5.25)
    Urinary tract infection (Yes vs No)
     During hospitalisation1.30 (0.82 to 2.06)1.45 (0.82 to 2.55)
     At 3 months1.23 (0.87 to 1.73)1.09 (0.69 to 1.71)
     At 6 months1.25 (0.90 to 1.74)1.08 (0.70 to 1.65)
     At 12 months1.32 (0.96 to 1.81)1.06 (0.70 to 1.60)
    Gastrointestinal bleeding (Yes vs No)
     During hospitalisation2.31 (1.54 to 3.45)1.08 (0.64 to 1.82)
     At 3 months3.38 (2.48 to 4.60)1.36 (0.89 to 2.09)
     At 6 months3.56 (2.62 to 4.84)1.46 (0.96 to 2.21)
     At 12 months3.74 (2.75 to 5.08)1.57 (1.03 to 2.39)
    Decubitus ulcers (Yes vs No)
     During hospitalisation1.93 (0.74 to 5.07)1.02 (0.32 to 3.24)
     At 3 months2.93 (1.43 to 6.02)1.29 (0.52 to 3.16)
     At 6 months4.26 (2.09 to 8.69)1.85 (0.77 to 4.42)
     At 12 months3.98 (1.94 to 8.16)1.33 (0.55 to 3.22)
    • Adjusted factors include age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores, haematoma volume, haematoma location, hypertension, diabetes mellitus, hyperlipidaemia, history of transient ischaemic attack (TIA), history of coronary heart disease (CHD), family history of stroke, atrial fibrillation (AF), current smoking status, dysphagia, heavy alcohol intake, anticoagulant treatment, thrombolytic treatment and types of health insurance.

    • ICH, intracerebral haemorrhage.

  • Table 3

    Unadjusted and adjusted ORs of having one or more medical complications during hospitalisation for death in patients at various time points following intracerebral haemorrhage

    OutcomesUnadjusted OR (95% CI)Adjusted OR (95% CI)*
    Death during hospitalisation5.31 (4.14 to 6.82)4.41 (3.18 to 6.12)
    Death at 3 months4.11 (3.43 to 4.92)2.18 (1.70 to 2.80)
    Death at 6 months3.78 (3.17 to 4.49)1.84 (1.45 to 2.34)
    Death at 12 months3.48 (2.94 to 4.12)1.59 (1.26 to 2.01)
    • *Adjusted factors include age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores, haematoma volume, haematoma location, hypertension, diabetes mellitus, hyperlipidaemia, history of transient ischaemic attack (TIA), history of coronary heart disease (CHD), family history of stroke, atrial fibrillation (AF), current smoking status, dysphagia, heavy alcohol intake, anticoagulant treatment, thrombolytic treatment and types of health insurance.

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In-hospital complications affect short-term and long-term mortality in ICH: a prospective cohort study
Yaqing Zhang, Yongjun Wang, Ruijun Ji, Anxin Wang, Yilong Wang, Zhonghua Yang, Liping Liu, Penglian Wang, Xingquan Zhao
Stroke and Vascular Neurology Jun 2021, 6 (2) 201-206; DOI: 10.1136/svn-2020-000386

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In-hospital complications affect short-term and long-term mortality in ICH: a prospective cohort study
Yaqing Zhang, Yongjun Wang, Ruijun Ji, Anxin Wang, Yilong Wang, Zhonghua Yang, Liping Liu, Penglian Wang, Xingquan Zhao
Stroke and Vascular Neurology Jun 2021, 6 (2) 201-206; DOI: 10.1136/svn-2020-000386
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In-hospital complications affect short-term and long-term mortality in ICH: a prospective cohort study
Yaqing Zhang, Yongjun Wang, Ruijun Ji, Anxin Wang, Yilong Wang, Zhonghua Yang, Liping Liu, Penglian Wang, Xingquan Zhao
Stroke and Vascular Neurology Jun 2021, 6 (2) 201-206; DOI: 10.1136/svn-2020-000386
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