Clinical Characteristics and Outcomes of Intracerebral Hemorrhage in Very Elderly

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Background

Intracerebral hemorrhage (ICH) incidences increase with age. Patients of advanced age may have limitations during acute care and recovery. We investigated baseline characteristics, hematoma features, and outcomes of very elderly ICH patients (≥80 years old) and compared them with those of younger ICH patients (<80 years old).

Methods

We studied 377 patients (122 women; 69 ± 11 years old) admitted within 24 hours of ICH onset. Outcome measures included hematoma volumes, National Institutes of Health Stroke Scale scores on admission, and vital and functional prognoses at 30 days.

Results

After adjustments for sex, very elderly patients had a higher subcortical hematoma prevalence (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.39-4.86]. On multivariate analyses, very elderly patients had larger hematoma volumes (OR, 1.33; 95% CI, 1.01-1.75, per 10-mL increase). After adjustments for risk factors and comorbidities, modified Rankin scale scores of 0-2 in very elderly patients occurred less often (OR, .34; 95% CI, .14-.82), and those with scores of 5-6 occurred more often (OR, 3.01; 95% CI, 1.09-8.54).

Conclusions

Hematomas were relatively large and often found in the subcortex in very elderly ICH patients. Outcomes of very elderly ICH patients were relatively poor.

Introduction

The incidence of intracerebral hemorrhage (ICH) increases with advancing age, and one study reported no decrease in community-based ICH incidence.1 The number of individuals older than 80 years of age has been rising during the last decade in most countries, including the United States and countries in Europe.2, 3 A previous study reported data for ICH patients of 85 years and older and found unfavorable outcomes compared with outcomes for younger counterparts.4 However, quantitative clinical data on admission severity, hematoma volume, and National Institutes of Health Stroke Scale (NIHSS) scores or outcomes represented by modified Rankin scale (mRS) scores of isolated very elderly ICH patients have not been reported. Therefore, we formed a single-center registry of acute ICH inpatients. In the initial report, we found that low admission serum calcium levels were associated with larger hematoma volumes and higher NIHSS scores.5 In the present study, we investigated the clinical findings and outcomes of very elderly patients with acute ICH.

Section snippets

Patients

We used our prospectively collected database of stroke inpatients to retrospectively study consecutive patients with nontraumatic ICH identified by noncontrast computed tomography who had been admitted to our department within 24 hours of ICH onset from January 2004 through June 2009. Fifty-one patients with ICH associated with vascular malformations, aneurysms, tumors, and impaired coagulation (e.g., disseminated intravascular coagulation syndrome) and those with primary intraventricular

Results

A total of 377 patients (122 women, 69 ± 11 years old) who had had primary ICH were admitted to our department within 24 hours of ICH onset. Of these patients, 67 (17.8%) were placed in the very elderly ICH group, and 310 (82.2%) were placed in the younger ICH group. The median initial hematoma volume was 10 mL (IQR, 4-25 mL), and the median initial NIHSS score was 12 (IQR, 6-18). The hematomas occurred mainly in the thalamoganglionic region (in 254 patients, 67.4%).

Table 1 shows baseline

Discussion

In the present study, we investigated age-related clinical differences and outcomes of patients with acute ICH. Patients 80 years and older accounted for 17.8% of all ICH patients in the registry.

The major new findings included the following: first, ICH patients 80 years or older had a higher prevalence of lobar hematoma and a larger hematoma volume on the emergent visit than did patients who were younger; second, 30-day outcomes were worse in very elderly ICH patients than in younger ICH

References (19)

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This study was supported in part by a grant from the Japan Agency for Medical Research and Development (grant number 15ek0210025h0002).

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