Gender differences in long-term mortality after spontaneous intracerebral hemorrhage in southern Portugal.

INTRODUCTION: the prognosis of spontaneous intracerebral hemorrhage (SICH) remains poor. Understanding gender differences can clarify the clinico-epidemiological and process of care related factors that influence SICH prognosis. We analyzed the long-term gender differences of mortality after SICH in Algarve, southern Portugal. PATIENTS AND METHODS: analysis of consecutive community representative of SICH survivors (2009-2015). Logistic regression analysis and Kaplan-Meier method was used to assess gender differences on 1-year mortality and survival. We further analyzed if differences exist between 4 age and gender based subgroups (women <75 years, women ≥75 years, men <75 years, men ≥75 years). RESULTS: a total of 285 survivors were analyzed; majority men (66.3%). Women were 2 years older on average. Overall case fatality was 11.6% [CI: 8.3-15.8]. A non-statistically significant (P = .094) higher case-fatality rate was observed in women; men were more frequently admitted to stroke unit; women had more often poor functional outcome or modified Rankin scale (mRS) ≥3. Predictors of death were: being women with ≥ 75 years, in-hospital pneumonia and hospital discharge mRS ≥3. The likelihood of death was higher in women ≥75 years (OR = 2.91 [1.23-8.1], P = .035) in comparison to women <75 years and men ≥75 years. Women <75 years had the longest survivor time, whereas women ≥75 years the shortest survivor time (P < .001). CONCLUSION: gender and age interact to influence long-term mortality after SICH. Women ≥75 years are at increased risk of death and have reduced survival after SICH in southern Portugal. Further studies are needed to clarify the biological or social factors contributing for the poor prognosis in the very old women in the region.

Poor intensive stroke care is associated with short-term death after spontaneous intracerebral hemorrhage.

OBJECTIVES: The case fatality from spontaneous ICH (SICH) remains high. The quality and intensity of early treatment is one of the determinants of the outcome. We aimed to study the association of early intensive care, using the Intracerebral Hemorrhage-Specific Intensity of Care Quality Metrics (IHSICQM) with the 30-day in-hospital mortality in Algarve, Portugal. PATIENTS AND METHODS: analysis of prospective collected data of 157 consecutive SICH patients (2014-2016). Logistic regression was performed to assess the role of IHSICQM on the 30-day in-hospital mortality controlling for the most common clinical and radiological predictors of death. Receiver operating characteristic (ROC) curve was developed to evaluate the prediction accuracy of the IHSICQM score (C-statistics). RESULTS: forty-five (29 %) patients died. The group of deceased patients had lower intensity of care (lower IHSICQM score) and higher proportion of poor prognosis associated factors (pre-ICH functional dependency, intraventricular dissection/glycaemia). On the multivariate analysis, higher IHSICQM was associated with reduction of the odds of death, 0.27 (0.14-0.50) per each increasing point. The ROC curve showed a high discriminating ability of isolated IHSICQM in predicting the 30-day mortality (AUC = 0,95; 95 % CI = [0,86; 0,95]). CONCLUSION: the early intensity of quality of care independently predicts the 30-day in-hospital mortality. Quantification of the intensity of SICH is a valid tool to persuade improvement of SICH care, as well to help comparison of performances within and between hospitals.

Fine particulate air pollution and occurrence of spontaneous intracerebral hemorrhage in an area of low air pollution.

OBJECTIVES: The association between short-term ambient particulate matter ≤ 2.5 µm diameter (PM2.5) and spontaneous intracerebral hemorrhage (SICH) occurrence is unclear. We aimed to study the association of ambient PM2.5 with occurrence of SICH in an area of low air pollution in southern Portugal. PATIENTS AND METHODS: PM2.5 levels from the 3 days before the SICH event (Lag 1, 2, 3) was compared with one control period (Lag 15-17) using a case-crossover analysis. Conditional logistic regression was used to estimate the odds ratio (OR) with 95% confidence interval (CI). Analysis was stratified by gender, age, functional neurological status, type of SICH, environmental factors (temperature, humidity, time of day and season). RESULTS: Three-hundred and eight patients were included (2010-2015); mean age 70.8 years, 62.8% were males. The mean values (µg/l) of PM2.5 were higher on the case days (Lag1 = 7.76, Lag2 = 7.64, Lag3 = 7.74) compared to control period (Lag14-17 = 6.77). For each 10 µg/l increase, the likelihood of SICH increased 5.7% (95% CI = 1.020-1.095. P = .002). The strength of the association was higher in patients younger than 70 years (OR = 1.064, 95% CI = 1.009-1.122); without prior to SICH neurological disability (OR = 1.061, 95% CI 1.022-1.101); with non-lobar type (OR = 1.054, 95% CI = 1.012-1.099). A circadian and circannual pattern was present with increased strength of the association when SICH occurred in the morning time (OR = 1,067, 95% CI = 1.012-1.125), in the fall (OR = 1.118, 95% CI = 1.031-1.213) and the in the winter (OR = 1.064, 95% CI = 1.002-1.129). The association was also potentiated at lower temperature values. CONCLUSION: Short-term increases of PM2.5 are associated with occurrence of SICH in Algarve, a region of low ambient pollution. Patient and ambient level factors can influence the strength of this association.