title: Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis.
abstract: OBJECTIVE
  There is uncertainty about the long-term prognosis after spontaneous intracerebral haemorrhage (ICH). Therefore, we systematically reviewed the literature for studies reporting long-term survival and ICH recurrence, and their predictors.
  
  
  METHODS
  We searched Ovid Medline 1946-2011 inclusive for cohort studies of ≥50 patients reporting long-term (>30 days) outcome after ICH. Two reviewers independently extracted data from each study. We meta-analysed 1-year and 5-year survival data from population-based studies using a random effects model (and quantified inconsistency using the I2 statistic).
  
  
  RESULTS
  We identified 122 eligible studies. The pooled estimate of 1-year survival was 46% (95% CI 43% to 49%; nine population-based studies (n=2408); I2=27%) and 5-year survival was 29% (95% CI 26% to 33%; three population-based studies (n=699); I2=6%). In 27 cohort studies, predictors most consistently associated with death were increasing age, decreasing Glasgow Coma Scale score, increasing ICH volume, presence of intraventricular haemorrhage, and deep/infratentorial ICH location. The annual risk of recurrent ICH varied from 1.3% to 7.4% in nine studies and this risk was higher after lobar ICH than non-lobar ICH in two of three hospital-based studies. Four studies reporting the risks of recurrent ICH and ischaemic stroke after ICH found no significant differences between these risks.
  
  
  CONCLUSIONS
  Less than a half of patients with ICH survive 1 year and less than a third survive 5 years. Risks of recurrent ICH and ischaemic stroke after ICH appear similar after ICH, provoking uncertainties about the use of antithrombotic drugs.
authors.affiliation: Edinburgh Medical School, The University of Edinburgh, , Edinburgh, UK.
authors.forename: Michael Tin Chung
authors.initials: MT
authors.lastname: Poon
authors.forename: Arthur François
authors.initials: AF
authors.lastname: Fonville
authors.forename: Rustam
authors.initials: R
authors.lastname: Al-Shahi Salman
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications / Q000401:mortality*; D002986:Clinical Trials as Topic; D015600:Glasgow Coma Scale; D006801:Humans; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors
keywords: Cerebrovascular; Stroke