Withdrawal of active treatment after intracerebral haemorrhage in the INTERACT2 study.
in the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and final outcome.



the INTERACT2 cohort of acute intracerebral haemorrhage (ICH) patients had a decision of WAT within 7 days after hospital admission recorded. Multivariable logistic regression was used to identify the determinants of WAT and poor outcome at 90 days, defined by modified Rankin scale (mRS) scores 3-6.



of 2,779 participants with available data, WAT occurred in 121 (4%) and this was significantly associated with increasing age, greater neurological severity, larger haematoma volume, intraventricular extension and randomisation to intensive BP lowering. Compared to other patients, those with WAT had greater mortality (81/121 [67%] versus 205/2624 [8%]; P < 0.001) and survivors were more likely to be severely disabled (mRS score 4-5, 19/39 [49%] versus 695/2419 [29%]; P = 0.006).



WAT was undertaken in patients with recognised predictors of poor prognosis, who subsequently were more likely to die or be left with severe disability. Improved understanding of specific factors determining WAT in ICH patients might improve care delivery and outcomes.



the INTERACT2 study is registered with ClinicalTrials.gov (NCT00716079).
Neurological and Mental Health division, The George Institute for Global Health, Sydney, New South Wales, Australia.|School of Public Health, University of Sydney, Sydney, NSW, Australia.|Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina Interna, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Paula
P
Muñoz Venturelli
Neurological and Mental Health division, The George Institute for Global Health, Sydney, New South Wales, Australia.|School of Public Health, University of Sydney, Sydney, NSW, Australia.
Xia
X
Wang
Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, USA.
Darin B
DB
Zahuranec
Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina Interna, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.|Departamento de Ciencias Neurológicas, Universidad de Chile, Santiago, Chile.
Pablo M
PM
Lavados
Department of Neurology and Department of Neuroscience, CRCHUM, University of Montreal, Quebec, Canada.
Christian
C
Stapf
Neurological and Mental Health division, The George Institute for Global Health, Sydney, New South Wales, Australia.
Richard
R
Lindley
Neurological and Mental Health division, The George Institute for Global Health, Sydney, New South Wales, Australia.|Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
Candice
C
Delcourt
Neurological and Mental Health division, The George Institute for Global Health, Sydney, New South Wales, Australia.
John
J
Chalmers
Neurological and Mental Health division, The George Institute for Global Health, Sydney, New South Wales, Australia.|Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
Craig S
CS
Anderson
Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK.
Thompson G
TG
Robinson
Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK.
Thompson G
TG
Robinson
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment
Intracerebral haemorrhage; older people; outcome; prognosis; withdrawal of care; withdrawal of treatment