Comparison of outcomes after intracerebral hemorrhage and ischemic stroke.
BACKGROUND
Intracerebral hemorrhage (ICH) is associated with a greater average initial stroke severity, higher mortality, and poorer long-term neurologic outcomes than ischemic stroke. The purpose of this study was to determine whether the poorer prognosis of ICH is independent of initial stroke severity.


METHODS
We analyzed data from the Glycine Antagonist in Neuroprotection (GAIN) Americas trial, in which 1604 non-obtunded patients with acute stroke were treated within 6 hours of symptom onset irrespective of hemorrhagic (N = 237) versus ischemic (N = 1367) subtype. Multiple logistic regression analysis was performed to evaluate predictors of mortality and neurologic outcome (modified Rankin scale [mRS] score of 0-1 v 2-6 at 3 months) adjusting for baseline National Institutes of Health Stroke Scale score, stroke risk factors, clinical and demographic characteristics, and gavestinel treatment group. Multiple linear regression techniques were used to assess the impact of various predictors on the full mRS score at 3 months.


RESULTS
ICH significantly increased the odds of a poor neurologic outcome (odds ratio 1.94, 95% confidence interval 1.23-3.06) and was independently associated with a mean 0.25-point increase in the 3-month mRS score (P = .04). ICH had no effect on mortality compared with ischemic stroke (odds ratio 1.01, 95% confidence interval .68-1.49) after adjusting for initial stroke severity (National Institutes of Health Stroke Scale score) and other baseline characteristics.


CONCLUSIONS
Among conscious stroke patients, ICH is an independent predictor of poor neurologic outcome, nearly doubling the odds of long-term disability. However, ICH is not associated with higher mortality compared with ischemic stroke after adjusting for initial stroke severity and other baseline characteristics.
Chiu
David
D
Methodist Neurological Institute, Weill Cornell Medical College, Houston, TX. Electronic address: dchiu@tmhs.org.
Peterson
Leif
L
Methodist Neurological Institute, Weill Cornell Medical College, Houston, TX.
Elkind
Mitchell S V
MSV
College of Physicians and Surgeons, Columbia University, New York, New York.
Rosand
Jonathan
J
Vascular and Critical Care Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston.
Gerber
Linda M
LM
Weill Cornell Medical College, Department of Public Health, New York, NY.
Silverstein
Marc D
MD
Methodist Neurological Institute, Weill Cornell Medical College, Houston, TX.
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000628:therapy*; D015331:Cohort Studies; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D005998:Glycine / Q000037:antagonists & inhibitors; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
D005998:Glycine