Functional outcome improvement from 3 to 12 months after intracerebral hemorrhage
Andrea Morotti, Jawed Nawabi, Andrea Pilotto, Maddalena Toffali, Giorgio Busto, Federico Mazzacane, Anna Cavallini, Michele Laudisi, Luana Gentile, Maria Maddalena Viola, Frieder Schlunk, Diletta Bartolini, Maurizio Paciaroni, Mauro Magoni, Maria Chiara Bassi, L. Simonetti, Enrico Fainardi, Ilaria Casetta, Andrea Zini, Alessandro Padovani
Abstract
Abstract Introduction: Most intracerebral hemorrhage (ICH) trials assessed outcome at 3 months but the recovery trajectory of ICH survivors may continue up to 1 year after the index event. We aimed to describe the predictors of functional outcome improvement from 3 to 12 months after ICH. Materials and Methods: Retrospective analysis of patients admitted to six European Stroke Centers for supratentorial ICH. Functional outcome was measured with the modified Rankin Scale (mRS) at 3 and 12 months. Predictors of functional outcome improvement were explored with binary logistic regression. Results: We included 703 patients, of whom 245 (34.9%) died within 3 months. Among survivors, 131 (28.6%) had an mRS improvement, 78 (17.0%) had a worse mRS and 249 (54.4%) had a stable functional status at 12 months. Older age and the presence of baseline disability (defined as pre-stroke mRS > 1), were associated with lower odds of functional outcome improvement (Odds Ratio (OR) 0.98 per year increase, 95% Confidence Interval (CI) 0.96–1.00, p = 0.017 and OR 0.45, 95% CI 0.25–0.81, p = 0.008 respectively). Conversely, deep ICH location increased the probability of long term mRS improvement (OR 1.67, 95% CI, 1.07–2.61, p = 0.023). Patients with mild-moderate disability at 3 months (mRS 2–3) had the highest odds of improvement at 12 months (OR 8.76, 95% CI 3.68–20.86, p < 0.001). Discussion and Conclusion: Long term recovery is common after ICH and associated with age, baseline functional status, mRS at 3 months and hematoma location. Our findings might inform future trials and improve long-term prognostication in clinical practice.