title: Circadian variation in clinical features and outcome of intracerebral hemorrhage: The INTERACT studies.
abstract: Previous studies consistently reported a diurnal variation in the occurrence of intracerebral hemorrhage (ICH), with a morning peak. However, limited knowledge exists on the circadian pattern of ICH severity and outcome. This study aimed to determine possible associations between ICH onset time and admission severity and 90-day outcomes using the combined data set of the pilot and main-phase Intensive blood pressure (BP) reduction in an acute cerebral hemorrhage trial (INTERACT). The ICH onset time was categorized into three groups (1: 00:00-07:59; 2: 08:00-15:59; and 3: 16:00-23:59). We found an association between onset time and low Glasgow Coma Scale score: aOR (time 1: 1.72, 95% CI 1.12-2.66; time 3: 1.95, 95% CI 1.31-2.89, p = 0.003; in comparison to time 2). There was no association between onset time and volume of ICH (adjusted p = 0.354) or 90-day outcomes of death or major disability, and death and major disability separately (all adjusted p > 0.4). The results showed that more severe cases of ICH patients, defined by a reduced level of consciousness, had late afternoon to early morning stroke onset, but this was unrelated to baseline hematoma volume or location. There was no circadian influence on ICH clinical outcome.
authors.affiliation: a Neurological and Mental Health Division, The George Institute for Global Health , Sydney , Australia.|b Sydney Medical School, The University of Sydney , Sydney , Australia.
authors.forename: Danni
authors.initials: D
authors.lastname: Zheng
authors.affiliation: a Neurological and Mental Health Division, The George Institute for Global Health , Sydney , Australia.|c Department of Cerebrovascular Medicine , National Cerebral and Cardiovascular Center , Osaka , Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.affiliation: a Neurological and Mental Health Division, The George Institute for Global Health , Sydney , Australia.|d Department of Neurology , The Second Affiliated Hospital of Soochow University , Suzhou , China.
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Cao
authors.affiliation: a Neurological and Mental Health Division, The George Institute for Global Health , Sydney , Australia.|e Department of Preventive Medicine and Public Health , Faculty of Medicine, Fukuoka University , Fukuoka , Japan.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: a Neurological and Mental Health Division, The George Institute for Global Health , Sydney , Australia.|f Department of Neurology , Royal Prince Alfred Hospital , Sydney , Australia.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Carcel
authors.affiliation: a Neurological and Mental Health Division, The George Institute for Global Health , Sydney , Australia.|b Sydney Medical School, The University of Sydney , Sydney , Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: a Neurological and Mental Health Division, The George Institute for Global Health , Sydney , Australia.|b Sydney Medical School, The University of Sydney , Sydney , Australia.|f Department of Neurology , Royal Prince Alfred Hospital , Sydney , Australia.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000473:pathology / Q000503:physiopathology*; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D000959:Antihypertensive Agents
keywords: Hemorrhagic stroke; cerebral hemorrhage; circadian rhythm; diurnal variation