title: Intracerebral Hemorrhage Outcomes in Patients with Systemic Cancer.
abstract: BACKGROUND
  Single-center studies suggest that patients with cancer have similar outcomes after intracerebral hemorrhage (ICH) compared to patients without cancer. However, these studies were limited by small sample sizes and high rates of intratumoral hemorrhage. Our hypothesis was that systemic cancer patients without brain involvement fare worse after ICH than patients without cancer.
  
  
  METHODS
  We identified all patients diagnosed with spontaneous ICH from 2002 to 2011 in the Nationwide Inpatient Sample. Our predictor variable was systemic cancer. Our primary outcome was discharge disposition, dichotomized into favorable discharge (home/self-care or rehabilitation) or unfavorable discharge (nursing facility, hospice, or death). We used logistic regression to compare outcomes and performed secondary analyses by cancer subtype (i.e., nonmetastatic solid tumors, nonmetastatic hematologic tumors, and metastatic solid or hematologic tumors).
  
  
  RESULTS
  Among 597,046 identified ICH patients, 22,394 (3.8%) had systemic cancer. Stroke risk factors such as hypertension and diabetes were more common in patients without cancer, whereas anticoagulant use and higher Charlson comorbidity scores were more common among cancer patients. In multivariate logistic regression analysis adjusted for demographics, comorbidities, and hospital-level characteristics, patients with cancer had higher odds of death (OR 1.62, 95% CI 1.56-1.69) and lower odds of favorable discharge (OR .59, 95% CI .56-.63) than patients without cancer. Among cancer groups, patients with nonmetastatic hematologic tumors and those with metastatic disease fared the worst.
  
  
  CONCLUSIONS
  Patients with systemic cancer have higher mortality and less favorable discharge outcomes after ICH than patients without cancer. Cancer subtype may influence outcomes after ICH.
authors: Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York. Electronic address: sam9200@med.cornell.edu.
authors: Santosh B
authors: SB
authors: Murthy
authors: Department of Hematology and Medical Oncology, Albert Einstein College of Medicine, Bronx, New York.
authors: Aditi
authors: A
authors: Shastri
authors: Department of Neurology, Weill Cornell Medical College, New York, New York.
authors: Alexander E
authors: AE
authors: Merkler
authors: Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Daniel F
authors: DF
authors: Hanley
authors: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Wendy C
authors: WC
authors: Ziai
authors: Department of Neurology, Weill Cornell Medical College, New York, New York.
authors: Matthew E
authors: ME
authors: Fink
authors: Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
authors: Costantino
authors: C
authors: Iadecola
authors: Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
authors: Hooman
authors: H
authors: Kamel
authors: Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
authors: Babak B
authors: BB
authors: Navi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D017051:Hospice Care; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D010351:Patient Discharge; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012648:Self Care; D012866:Skilled Nursing Facilities; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Intracerebral hemorrhage; cancer; clinical outcomes; malignancy