A comprehensive comparison of machine learning models for ICH prognostication: Retrospective review of 1501 intra-cerebral hemorrhage patients from the Qatar stroke database.

Multiple prognostic scores have been developed to predict morbidity and mortality in patients with spontaneous intracerebral hemorrhage(sICH). Since the advent of machine learning(ML), different ML models have also been developed for sICH prognostication. There is however a need to verify the validity of these ML models in diverse patient populations. We aim to create machine learning models for prognostication purposes in the Qatari population. By incorporating inpatient variables into model development, we aim to leverage more information. 1501 consecutive patients with acute sICH admitted to Hamad General Hospital(HGH) between 2013 and 2023 were included. We trained, evaluated, and compared several ML models to predict 90-day mortality and functional outcomes. For our dataset, we randomly selected 80% patients for model training and 20% for validation and used k-fold cross validation to train our models. The ML workflow included imbalanced class correction and dimensionality reduction in order to evaluate the effect of each. Evaluation metrics such as sensitivity, specificity, F-1 score were calculated for each prognostic model. Mean age was 50.8(SD 13.1) years and 1257(83.7%) were male. Median ICH volume was 7.5 ml(IQR 12.6). 222(14.8%) died while 897(59.7%) achieved good functional outcome at 90 days. For 90-day mortality, random forest(RF) achieved highest AUC(0.906) whereas for 90-day functional outcomes, logistic regression(LR) achieved highest AUC(0.888). Ensembling provided similar results to the best performing models, namely RF and LR, obtaining an AUC of 0.904 for mortality and 0.883 for functional outcomes. Random Forest achieved the highest AUC for 90-day mortality, and LR achieved the highest AUC for 90-day functional outcomes. Comparing ML models, there is minimal difference between their performance. By creating an ensemble of our best performing individual models we maintained maximum accuracy and decreased variance of functional outcome and mortality prediction when compared with individual models.

Factors associated with 90-day mortality in Vietnamese stroke patients: Prospective findings compared with explainable machine learning, multicenter study.

The prevalence and predictors of mortality following an ischemic stroke or intracerebral hemorrhage have not been well established among patients in Vietnam. 2885 consecutive diagnosed patients with ischemic stroke and intracerebral hemorrhage at ten stroke centres across Vietnam were involved in this prospective study. Posthoc analyses were performed in 2209 subjects (age was 65.4 ± 13.7 years, with 61.4% being male) to explore the clinical characteristics and prognostic factors associated with 90-day mortality following treatment. An explainable machine learning model using extreme gradient boosting and SHapley Additive exPlanations revealed the correlation between original clinical research and advanced machine learning methods in stroke care. In the 90 days following treatment, the mortality rate for ischemic stroke was 8.2%, while for intracerebral hemorrhage, it was higher at 20.5%. Atrial fibrillation was an elevated risk of 90-day mortality in the ischemic stroke patient (OR 3.09; 95% CI 1.90-5.02, p<0.001). Among patients with intracerebral hemorrhage, there was no statistical significance in those with hypertension compared to their counterparts without hypertension (OR 0.65, 95% CI 0.41-1.03, p > 0.05). The baseline NIHSS score was a significant predictor of 90-day mortality in both patient groups. The machine learning model can predict a 0.91 accuracy prediction of death rate after 90 days. Age and NIHSS score were in the top high risks with other features, such as consciousness, heart rate, and white blood cells. Stroke severity, as measured by the NIHSS, was identified as a predictor of mortality at discharge and the 90-day mark in both patient groups.

Acute Myocardial Injury in Spontaneous Intracerebral Hemorrhage: A Secondary Observational Analysis of the FAST Trial.

BACKGROUND: Acute myocardial injury is associated with poor outcomes in patients with acute ischemic stroke, but its prognostic significance in patients with spontaneous intracerebral hemorrhage remains unclear. We investigated whether acute myocardial injury and the direction of the cardiac troponin I (cTnI) change (rising versus falling) affect post-intracerebral hemorrhage outcomes. METHODS AND RESULTS: We re-analyzed the FAST (Factor-Seven-for-Acute-Hemorrhagic-Stroke) trial. Acute myocardial injury was defined as at least 1 cTnI value above the upper reference limit with a rise/fall of >20%. Logistic regression tested for associations (1) between acute myocardial injury (presence versus absence) and poor outcome (modified Rankin Scale 4-6) and mortality at 15 and 90 days; (2) among 3 groups (rising versus falling versus no acute myocardial injury) and outcomes. Among the 841 FAST participants, 785 patients were included. Acute myocardial injury was detected in 29% (n=227); 170 had rising cTnI. At 15 and 90 days, respectively, those with acute myocardial injury had higher odds of poor outcome (adjusted odds ratio) ([aOR] 2.3 [95% CI, 1.3-3.9]); and adjusted odds ratio 2.5 [95% CI, 1.6-3.9];, and higher odds of mortality (adjusted odds ratio 2.4 [95% CI, 1.4-4.3]; and adjusted odds ratio 2.2 [CI, 1.3-3.6]) than patients without. There was no interaction between FAST group assignment and myocardial injury, and associations between myocardial injury and outcomes were consistent across group assignments. Rising cTnI was associated with the highest risk of poor outcomes and mortality. CONCLUSIONS: In this secondary analysis of the FAST trial, acute myocardial injury was common and associated with poor outcomes. The direction of the cTnI change might provide additional risk stratification after intracerebral hemorrhage.

Characteristics, predictors and outcomes of early postoperative cerebral infarction on computed tomography in spontaneous intracerebral hemorrhage.

Early postoperative cerebral infarction (ePCI) is a serious complication of spontaneous intracerebral hemorrhage (SICH). Yet, no study has specifically focused on ePCI among SICH patients. Our study aims to investigate the characteristics, predictors, and outcomes of ePCI observed on computed tomography (CT) within 72 h after surgery in patients with supratentorial SICH. Data from a single-center SICH study conducted from May 2015 to September 2022 were retrospectively analyzed. We described the characteristics of ePCI. Predictors were identified through logistic regression analysis, and the impact of ePCI on six-month mortality was examined using a Cox regression model. Subgroup analyses and the "E-value" approach assessed the robustness of the association between ePCI and mortality. A retrospective analysis of 637 out of 3938 SICH patients found that 71 cases (11.1%) developed ePCI. The majority of ePCI cases occurred on the bleeding side (40/71, 56.3%) and affected the middle cerebral artery (MCA) territory (45/71, 63.4%). Multivariable analysis showed that the Glasgow Coma Scale (GCS) score (odds ratio (OR), 0.62; 95% CI, 0.48-0.8; p < 0.001), bleeding volume (per 100 ml) (OR, 1.17; 95% CI, 1.03-1.32; p = 0.016), hematoma volume (per 10 ml) (OR, 1.14; 95%CI, 1.02-1.28; p = 0.023) and bilateral brain hernia (OR, 6.48; 95%CI, 1.71-24.48; p = 0.006) independently predicted ePCI occurrence. ePCI was significantly associated with increased mortality (adjusted hazard ratio (HR), 3.6; 95% CI, 2.2-5.88; p < 0.001). Subgroup analysis and E-value analysis (3.82-6.66) confirmed the stability of the association. ePCI is a common complication of SICH and can be predicted by low GCS score, significant bleeding, large hematoma volume, and brain hernia. Given its significant increase in mortality, ePCI should be explored in future studies.

The clinical value of inflammation index in predicting ICU mortality of critically ill patients with intracerebral hemorrhage.

Background: The inflammatory response holds paramount significance in the context of intracerebral hemorrhage (ICH) and exhibits a robust correlation with mortality rates. Biological markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune inflammation index (SII), and systemic inflammatory response index (SIRI) play crucial roles in influencing the systemic inflammatory response following ICH. This study aims to compare the predictive efficacy of NLR, PLR, LMR, SII, and SIRI concerning the risk of mortality in the intensive care unit (ICU) among critically ill patients with ICH. Such a comparison seeks to elucidate their early warning capabilities in the management and treatment of ICH. Methods: Patients with severe ICH requiring admission to the ICU were screened from the Medical Information Marketplace for Intensive Care (MIMIC-IV) database. The outcomes studied included ICU mortality and 30 day ICU hospitalization rates, based on tertiles of the NLR index level. To explore the relationship between the NLR index and clinical outcomes in critically ill patients with ICH, we utilized receiver operating characteristic (ROC) analysis, decision curve analysis (DCA), and multivariate logistic regression analysis. Results: A total of 869 patients (51.9% male) were included in the study, with an ICU mortality rate of 22.9% and a 30 day ICU hospitalization rate of 98.4%. Among the five indicators examined, both the ROC curve and DCA indicated that NLR (AUC: 0.660, 95%CI: 0.617-0.703) had the highest predictive ability for ICU mortality. Moreover, this association remained significant even after adjusting for other confounding factors during multivariate analysis (HR: 3.520, 95%CI: 2.039-6.077). Based on the results of the multivariate analysis, incorporating age, albumin, lactic acid, NLR, and GCS score as variables, we developed a nomogram to predict ICU mortality in critically ill patients with ICH. Conclusion: NLR emerges as the most effective predictor of ICU mortality risk among critically ill patients grappling with ICH when compared to the other four indicators. Furthermore, the integration of albumin and lactic acid indicators into the NLR nomogram enhances the ability to promptly identify ICU mortality in individuals facing severe ICH.

Diabetes mellitus is associated with worse long-term functional outcomes in primary intracerebral hemorrhage survivors - A prospective study.

OBJECTIVE: Primary intracerebral hemorrhage (ICH) accounts for 85 % of ICH and is associated with high morbidity and mortality. Identification of prognostic factors is critical to its management. However, previous studies showed conflicting results in whether diabetes mellitus (DM) is associated with outcomes among ICH patients. The present study examined the association between DM and long-term functional outcomes prospectively after ICH. DESIGN: This prospective study examined the functional outcomes in primary ICH patients. This study excluded patients who died before discharge and those with ICH related to aneurysm, arteriovenous malformation, or trauma. Patients were followed up for 1 year after ICH. Functional outcome was based on the Barthel Index (BI). Severe dependency in ADL was defined by a BI of ≤60, and functional independence was defined by a BI of >90. RESULTS: A total of 100 patients completed the 1-year follow-up, and 24 patients had DM. DM was significantly associated with worse functional outcomes 1 year post-ICH. The association remained significant after adjusting for baseline characteristics, comorbidities, and ICH score. CONCLUSION: DM was an independent predictor of worse functional outcomes 1 year post-ICH. This study is the first to examine the effect of DM on long-term functional outcomes after ICH.

Systemic immune-inflammation index and serum glucose-potassium ratio predict poor prognosis in patients with spontaneous cerebral hemorrhage: An observational study.

Recent studies have shown systemic inflammatory response, serum glucose, and serum potassium are associated with poor prognosis in spontaneous intracerebral hemorrhage (SICH). This retrospective study aimed to investigate the association of systemic immune-inflammatory index (SII) and serum glucose-potassium ratio (GPR) with the severity of disease and the poor prognosis of patients with SICH at 3 months after hospital discharge. We reviewed the clinical data of 105 patients with SICH, assessed the extent of their disease using Glasgow Coma Scale score, National Institutes of Health Stroke Scale (NIHSS) score, and hematoma volume, and categorized them into a good prognosis group (0-3 scores) and a poor prognosis group (4-6 scores) based on their mRS scores at 3 months after hospital discharge. Demographic characteristics, clinical, laboratory, and imaging data at admission were compared between the 2 groups, bivariate correlations were analyzed using Spearman's correlation coefficients, multivariate logistic regression analysis was used to determine the independent risk factors for poor prognosis of patients with SICH, and finally, SII, GPR, and platelet/lymphocyte ratio (PLR) were examined using the subject's work characteristics (ROC) curve, lymphocyte/monocyte ratio (LMR), and neutrophil/lymphocyte ratio (NLR) for their predictive efficacy for poor prognosis. Patients in the poor prognosis group had significantly higher SII and serum GPR than those in the good prognosis group, and Spearman analysis showed that SII and serum GPR were significantly correlated with the admission Glasgow Coma Scale score as well as the NIHSS score and that SII and GPR increased with the increase in mRS score. Multivariate logistic regression analysis showed that admission NIHSS score, hematoma volume SII, GPR, NLR, and PLR were independently associated with poor patient prognosis. Analysis of the subjects' work characteristic curves showed that the areas under the SII, GPR, NLR, PLR, LMR, and coSII-GPR curves were 0.838, 0.837, 0.825, 0.718, 0.616, and 0.883. SII and GRP were significantly associated with disease severity and short-term prognosis in SICH patients 3 months after discharge, and SII and GPR had better predictive value compared with NLR, PLR, and LMR. In addition, coSII-GPR, a joint indicator based on SII and GPR, can improve the predictive accuracy of poor prognosis 3 months after discharge in patients with SICH.

Temporal Trends and Racial Disparities in Long-Term Survival After Stroke.

BACKGROUND AND OBJECTIVES: Few studies have examined trends and disparities in long-term outcome after stroke in a representative US population. We used a population-based stroke study in the Greater Cincinnati Northern Kentucky region to examine trends and racial disparities in poststroke 5-year mortality. METHODS: All patients with acute ischemic strokes (AISs) and intracerebral hemorrhages (ICHs) among residents ≥20 years old were ascertained using ICD codes and physician-adjudicated using a consistent case definition during 5 periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, and 2015. Race was obtained from the medical record; only those identified as White or Black were included. Premorbid functional status was assessed using the modified Rankin Scale, with a score of 0-1 being considered "good." Mortality was assessed with the National Death Index. Trends and racial disparities for each subtype were analyzed with logistic regression. RESULTS: We identified 8,428 AIS cases (19.3% Black, 56.3% female, median age 72) and 1,501 ICH cases (23.5% Black, 54.8% female, median age 72). Among patients with AIS, 5-year mortality improved after adjustment for age, race, and sex (53% in 1993/94 to 48.3% in 2015, overall effect of study year p = 0.009). The absolute decline in 5-year mortality in patients with AIS was larger than what would be expected in the general population (5.1% vs 2.8%). Black individuals were at a higher risk of death after AIS (odds ratio [OR] 1.23, 95% CI 1.08-1.39) even after adjustment for age and sex, and this effect was consistent across study years. When premorbid functional status and comorbidities were included in the model, the primary effect of Black race was attenuated but race interacted with sex and premorbid functional status. Among male patients with a good baseline functional status, Black race remained associated with 5-year mortality (OR 1.4, 95% CI 1.1-1.7, p = 0.002). There were no changes in 5-year mortality after ICH over time (64.4% in 1993/94 to 69.2% in 2015, overall effect of study year p = 0.32). DISCUSSION: Long-term survival improved after AIS but not after ICH. Black individuals, particularly Black male patients with good premorbid function, have a higher mortality after AIS, and this disparity did not change over time.

Acute seizures after spontaneous intracerebral hemorrhage in young individuals: 11-year trends and association with mortality.

BACKGROUND: The rate of spontaneous Intracerebral Hemorrhage (sICH) is rising among young Americans. Trends in acute seizure (AS) incidence in this age group is largely unknown. Further, the association of AS with mortality has not been reported in this age group. The aim of this study is to determine trends in AS among young individuals with sICH. METHODS: The Merative MarketScan® Commercial Claims and Encounters database, for the years 2005 through 2015, served as the data source for this retrospective in-hospital population study. This period was chosen as spontaneous ICH incidence increased among young individuals between 2005 and 2015. Our study population included patients aged 18-64 years with ICH identified using the International Classification of Diseases, Ninth and Tenth Revision (ICD-9/10) codes 430, 431, 432.0, 432.1, 432.9, I61, I61.0, I61.1, I61.2, I61.3, I61.4, I61.5, I61.6, I61.8, and I61.9, excluding those with a prior diagnosis of seizures (ICD-9/10 codes 345.x,780.3x, G40, G41, and R56.8). We computed yearly AS incidence, mortality (in patients with and without seizures), and analyzed trends. We applied a logistic regression model to determine the independent association of AS with mortality accounting for demographic and clinical variables. RESULTS: AS incidence increased linearly between 2005 (incidence rate: 8.1 %) and 2015 (incidence rate: 11.0 %), which represents a 26 % relative increase (P for trends <0.0001). In-hospital mortality rate was 14.3 % among those who developed AS and 11.5 % among those who did not have AS. Overall, between 2005 and 2015, in-hospital mortality decreased from 13.0 % to 9.7 % among patients without AS but remained unchanged among those with AS. Patients who developed AS were 10 % more likely to die than those who did not (OR: 1.10, 95 % confidence interval: 1.02-1.18). CONCLUSIONS: Between 2005 and 2015, the incidence of AS increased by nearly 26 % among young Americans with sICH. In-patient mortality remained unchanged among those who developed seizures but declined among those who did not. The occurrence of AS was independently associated with a 10 % higher risk of in-hospital death.

Antithrombotics alter intracerebral hemorrhage presentation without affecting minimally invasive endoscopic evacuation.

OBJECTIVES: Intracerebral hemorrhages are associated with significant morbidity and mortality. While the ENRICH trial supports the efficacy of surgical evacuation for lobar hemorrhages, the impact of antithrombotic therapies on minimally invasive surgery outcomes remains unexplored. This study evaluates the effects of chronic anticoagulants and antiplatelets on the technical and longterm outcomes of minimally invasive intracerebral hemorrhage evacuation. MATERIALS AND METHODS: A prospectively collected registry of patients undergoing minimally invasive surgery for intracerebral hemorrhage from a single institution was analyzed (December 2015-September 2022). Data included key demographics, comorbidities, antithrombotic/reversal status, presenting clinical/radiographic characteristics, procedural metrics, and clinical outcomes. Patients were divided into control (neither therapy), antiplatelet-only, and anticoagulant-only groups, with antiplatelet/anticoagulant reversals conducted per current American Heart Association/American Stroke Association guidelines. Variables significant in univariate analyses (p<0.05) were advanced to multivariable regression models. RESULTS: Among 226 intracerebral hemorrhage patients treated with minimally invasive surgery, 41% (N=93) had antithrombotic medication history; 28% (N=64) received antiplatelets, and 9% (N=21) received anticoagulants. Patients on both therapies (N=6) were excluded. The antiplatelet group presented more frequently with lobar hemorrhages (56% vs. 37%; p=0.022), while patients on anticoagulants showed increased rates of intraventricular hemorrhage co-presentation (62% vs. 46%; p=0.011) compared to controls. Despite univariate analyses showing a higher postoperative hematoma volume (3.9 vs. 2.9 milliliters; p=0.020) and lower evacuation percentage (88% vs. 92%; p=0.019) for the antiplatelet group, and longer procedures for patients on anticoagulants (2.3 vs. 1.7 hours; p=0.042) compared to control, multivariable analyses indicated that antiplatelets and anticoagulants had no significant impact on these technical outcomes. Longitudinally, antithrombotics were not associated with increased rebleeding, less frequent discharge to home, lower 30-day mortality, or worse, 6-month Modified Rankin Scale scores. CONCLUSIONS: Patients on chronic antiplatelets and anticoagulants exhibited characteristic intracerebral hemorrhage phenotypes without worse technical or long-term outcomes after minimally invasive intracerebral hemorrhage evacuation, suggesting the procedure's safety for these patients.

Intracranial Pressure Monitoring in Patients with Spontaneous Intracerebral Hemorrhage: A Systematic Review with Meta-Analysis.

OBJECTIVE: To describe the potential effects of Intracranial pressure monitoring on the outcome of patients with spontaneous intracerebral hemorrhage (ICH). METHODS: This study is a systematic review with meta-analysis. Patients with spontaneous ICH treated with intracranial pressure monitoring were included. The primary outcome was mortality at 6 months and in-hospital mortality. The secondary outcome was poor neurological function outcome at 6 months. RESULTS: This analysis compares in-hospital and 6-month mortality rates between patients with intracranial pressure monitoring (ICPm) and those without (no ICPm). Although the ICPm group had a lower in-hospital mortality rate, it was not statistically significant (24.9% vs. 34.1%; OR 0.51, 95% CI 0.20 to 1.31, P = 0.16). Excluding patients with intraventricular hemorrhage revealed a significant reduction in in-hospital mortality for the ICPm group (23.5% vs. 43%; OR 0.39, 95% CI 0.29 to 0.53, P < 0.00001). For 6-month mortality, the ICPm group showed a significant reduction (32% vs. 39.6%; OR 0.76, 95% CI 0.61 to 0.94, P = 0.01), with the effect being more pronounced after excluding intraventricular hemorrhage patients (29.1% vs. 47.2%; OR 0.45, 95% CI 0.34 to 0.60, P < 0.0001). However, there were no statistically significant differences in 6-month functional outcomes between the groups. Increased ICP was associated with higher 3-month mortality (OR 1.12, 95% CI 1.07 to 1.18, P < 0.00001) and lower likelihood of good functional outcomes (OR 1.11, 95% CI 1.04 to 1.18, P < 0.00001). CONCLUSIONS: Elevated ICP is associated with increased mortality and poor prognosis in ICH patients. Although continuous intracranial pressure monitoring may reduce short-term mortality rates in specific subgroups of ICH patients, it does not improve neurological functional outcomes. While potential patient populations may benefit from ICP monitoring, more research is needed to screen suitable populations for ICP monitoring.

Disease burden of stroke and its subtypes attributable to low dietary fiber in China, 1990-2019.

This study aimed to assess the current status and changing trends of the disease burden of stroke and its subtypes due to low dietary fiber intake in China from 1990 to 2019. In cases of stroke and its subtypes attributable to low dietary fiber, deaths, disability-adjusted life-years (DALYs), age-standardized mortality rates (ASMR), age-standardized DALYs rates (ASDR), and percentage change were used to assess disease burden. Data were obtained from the 2019 global burden of disease study. Trends were assessed using Joinpoint regression and age-period-cohort analysis. Between 1990 and 2019, there was a declining trend in stroke and its subtypes, ASDR and ASMR, as well as the corresponding number of deaths and DALYs, due to low dietary fiber intake in China. Subarachnoid hemorrhage (SH) showed the greatest decrease, followed by intracerebral hemorrhage (IH) and ischemic stroke (IS). Local drift curves showed a U-shaped distribution of stroke, IS, and IH DALYs across the whole group and sex-based groups. For mortality, the overall and male trends were similar to those for DALYs, whereas female stroke, IH, and IS showed an upward trend. The DALYs for stroke and IH showed a clear bimodal distribution, IS showed an increasing risk with age. For mortality, the SH subtype showed a decreasing trend, whereas other subtypes showed an increasing risk with age. Both the period and cohort rates of stroke DALYs and motality due to low dietary fiber have declined. Males had a higher risk of DALYs and mortality associated with low fiber levels. The burden of stroke and its subtypes associated with a low-fiber diet in China has been declining over the past 30 years, with different patterns of change for different stroke subtypes and a higher burden for males, highlighting the differential impact of fiber intake on stroke and its subtypes.

Global burden of stroke in adolescents and young adults (aged 15-39 years) from 1990 to 2019: a comprehensive trend analysis based on the global burden of disease study 2019.

INTRODUCTION: The incidence of stroke is rising among individuals aged 15-39. Insufficient research targeting this age group hampers the development of effective strategies. This study analyzes data from the Global Burden of Disease Study 2019 (GBD 2019) to examine trends from 1990 to 2019 and propose future interventions. METHODS: Data on ischemic strokes, intracerebral hemorrhage, and subarachnoid hemorrhage from 1990 to 2019 was collected from the Global Health Data Exchange (GHDx) platform. We used the Annual Average Percentage Change (AAPC) to assess global trends in incidence, prevalence, Disability-Adjusted Life Years (DALYs), and mortality rates across various stroke categories. Joinpoint models identified significant years of trend inflection. Trend analyses were segmented by age, gender, and Sociodemographic Index (SDI). FINDINGS: From 1990 to 2019, the global incidence of ischemic stroke within the adolescents and young adults (AYAs) cohort declined from 1990 to 1999, further decreased from 2000 to 2009, and then increased from 2010 to 2019. The overall AAPC p-value showed no significant difference. Mortality rates for ischemic strokes were consistently reduced during this period. The overall incidence rate of intracerebral hemorrhage has exhibited a downward trend. Meanwhile, the incidence rate of subarachnoid hemorrhage decreased from 1990 to 2009, yet saw a resurgence from 2010 to 2019. Male ischemic stroke incidence grew more than female incidence, but both absolute incidence and rates were higher for females. Differences in SDI levels were observed, with the fastest increase in incidence occurring in low-middle SDI regions, followed by high SDI regions, and the smallest increase in low SDI regions. Conversely, the most rapid decline was noted in high-middle SDI regions, with no significant change observed in middle SDI regions. CONCLUSION: A concerning trend of increasing ischemic stroke incidence, DALYs, and prevalence rates has emerged in the global 15-39 age group, especially among those aged 30-39. This increase is evident across regions with varying SDI classifications. To combat this alarming trend among adolescents and young adults, enhancing preventive efforts, promoting healthier lifestyles, strengthening the healthcare system's responsiveness, and maintaining vigilant epidemiological monitoring is essential.

Prognostic relationship between high sensitivity troponin I level, hematoma volume and glasgow coma score in patients diagnosed with spontaneous intracerebral hemorrhage.

BACKGROUND: Intracranial hemorrhages is one of the major causes of mortality and morbidity worldwide, and there is still no effective biomarker to predict prognosis. AIM: We aimed to determine the effectiveness of high sensitive troponin I (hs-cTn-I) levels to predict the prognosis of spontaneous intracerebral hemorrhage (sICH) by comparing Glasgow Coma Score (GCS) and hematoma volume with hs-cTn-I levels. METHODS: This study was planned as a retrospective observational study. Patients with available data, over 18 years old and sICH were included in the study. Cerebral computed tomography images were evaluated by a senior radiologist. Hematoma volume was calculated using the ABC/2 formula. RESULTS: The study comprised 206 individuals in total 78 (37.86%) women and 128 (62.13%) men. Forty-four (21.35%) of patients died. The sensitivity of GCS, hs-cTn-I, and hematoma volume values were 86.36%, 66.67%, and 59.46%, respectively, with corresponding specificities of 78.75%, 93.02%, and 87.58%. Patients with hs-cTn-I values over 26, GCS values of ≤ 9, and hematoma volume values above 44.16 were found to have higher risk of mortality (p = 0.011; p < 0.001; p < 0.001, respectively). The mortality rates were found to be increased 2.586 (IQR: 1.224-5.463) times in patients with hs-cTn-I values above 26, 0.045 times (IQR: 0.018-0.115) in patients with GCS values ≤ 9, and 7.526 times (IQR: 3.518-16.100) in patients with hematoma volume values above 44.16. CONCLUSIONS: Our findings suggest that hs-cTn-I values exceeding 26 units may serve as effective biochemical markers for predicting the prognosis of patients with sICH.

Spot sign score is associated with hematoma expansion and longer hospital stay but not functional outcomes in primary intracerebral hemorrhage survivors.

PURPOSE: The computed tomography angiography (CTA) spot sign is a validated predictor of 30-day mortality in intracerebral hemorrhage (ICH). However, its role in predicting unfavorable functional outcomes remains unclear. This study explores the frequency of the spot sign and its association with functional outcomes, hematoma expansion, and length of hospital stay among survivors of ICH. MATERIALS AND METHODS: This was a retrospective analysis of consecutive patients with primary ICH who received CTA within 24 h of admission to two medical centers between January 2007 and August 2022. Patients who died before discharge and those referred from other hospitals were excluded. Spot signs were assessed by an experienced neuroradiologist. Functional outcomes were determined by modified Rankin Scale (mRS) scores and the Barthel Index (BI). RESULTS: In total, 98 patients were included; 14 (13.64%) had a spot sign. No significant differences were observed in the baseline characteristics between the patients with and without a spot sign. Higher spot sign scores were associated with higher odds of experiencing hematoma expansion (p = 0.013, 95% CI = 1.16-3.55), undergoing surgery (p = 0.012, 95% CI = 0.19-1.55), and having longer hospital stay (p = 0.02, 95% CI = 1.22-13.92). However, higher spot sign scores were not associated with unfavorable functional outcomes (p = 0.918 for BI, and p = 0.782 for mRS). CONCLUSION: Spot signs are common findings among patients with ICH, and higher spot sign scores were associated with subsequent hematoma expansion and longer hospital stays but not unfavorable functional outcomes.

Long-term survival of traumatic brain injury and intra-cerebral haemorrhage patients: A multicentric observational cohort.

PURPOSE: Mortality is often assessed during ICU stay and early after, but rarely at later stage. We aimed to compare the long-term mortality between TBI and ICH patients. MATERIALS AND METHODS: From an observational cohort, we studied 580 TBI patients and 435 ICH patients, admitted from January 2013 to February 2021 in 3 ICUs and alive at 7-days post-ICU discharge. We performed a Lasso-penalized Cox survival analysis. RESULTS: We estimated 7-year survival rates at 72.8% (95%CI from 67.3% to 78.7%) for ICH patients and at 84.9% (95%CI from 80.9% to 89.1%) for TBI patients: ICH patients presenting a higher mortality risk than TBI patients. Additionally, we identified variables associated with higher mortality risk (age, ICU length of stay, tracheostomy, low GCS, absence of intracranial pressure monitoring). We also observed anisocoria related with the mortality risk in the early stage after ICU stay. CONCLUSIONS: In this ICU survivor population with a prolonged follow-up, we highlight an acute risk of death after ICU stay, which seems to last longer in ICH patients. Several variables characteristic of disease severity appeared associated with long-term mortality, raising the hypothesis that the most severe patients deserve closer follow-up after ICU stay.

Machine learning for the prediction of in-hospital mortality in patients with spontaneous intracerebral hemorrhage in intensive care unit.

This study aimed to develop a machine learning (ML)-based tool for early and accurate prediction of in-hospital mortality risk in patients with spontaneous intracerebral hemorrhage (sICH) in the intensive care unit (ICU). We did a retrospective study in our study and identified cases of sICH from the MIMIC IV (n = 1486) and Zhejiang Hospital databases (n = 110). The model was constructed using features selected through LASSO regression. Among five well-known models, the selection of the best model was based on the area under the curve (AUC) in the validation cohort. We further analyzed calibration and decision curves to assess prediction results and visualized the impact of each variable on the model through SHapley Additive exPlanations. To facilitate accessibility, we also created a visual online calculation page for the model. The XGBoost exhibited high accuracy in both internal validation (AUC = 0.907) and external validation (AUC = 0.787) sets. Calibration curve and decision curve analyses showed that the model had no significant bias as well as being useful for supporting clinical decisions. XGBoost is an effective algorithm for predicting in-hospital mortality in patients with sICH, indicating its potential significance in the development of early warning systems.

Prognostic biomarkers of intracerebral hemorrhage identified using targeted proteomics and machine learning algorithms.

Early prognostication of patient outcomes in intracerebral hemorrhage (ICH) is critical for patient care. We aim to investigate protein biomarkers' role in prognosticating outcomes in ICH patients. We assessed 22 protein biomarkers using targeted proteomics in serum samples obtained from the ICH patient dataset (N = 150). We defined poor outcomes as modified Rankin scale score of 3-6. We incorporated clinical variables and protein biomarkers in regression models and random forest-based machine learning algorithms to predict poor outcomes and mortality. We report Odds Ratio (OR) or Hazard Ratio (HR) with 95% Confidence Interval (CI). We used five-fold cross-validation and bootstrapping for internal validation of prediction models. We included 149 patients for 90-day and 144 patients with ICH for 180-day outcome analyses. In multivariable logistic regression, UCH-L1 (adjusted OR 9.23; 95%CI 2.41-35.33), alpha-2-macroglobulin (aOR 5.57; 95%CI 1.26-24.59), and Serpin-A11 (aOR 9.33; 95%CI 1.09-79.94) were independent predictors of 90-day poor outcome; MMP-2 (aOR 6.32; 95%CI 1.82-21.90) was independent predictor of 180-day poor outcome. In multivariable Cox regression models, IGFBP-3 (aHR 2.08; 95%CI 1.24-3.48) predicted 90-day and MMP-9 (aOR 1.98; 95%CI 1.19-3.32) predicted 180-day mortality. Machine learning identified additional predictors, including haptoglobin for poor outcomes and UCH-L1, APO-C1, and MMP-2 for mortality prediction. Overall, random forest models outperformed regression models for predicting 180-day poor outcomes (AUC 0.89), and 90-day (AUC 0.81) and 180-day mortality (AUC 0.81). Serum biomarkers independently predicted short-term poor outcomes and mortality after ICH. Further research utilizing a multi-omics platform and temporal profiling is needed to explore additional biomarkers and refine predictive models for ICH prognosis.

Nationwide Big Data Analysis of Statin Use and Intracerebral Hemorrhage Risk in Acute Ischemic Stroke Patients in Taiwan.

Background and Objectives: Although statins are recommended for secondary prevention of acute ischemic stroke, some population-based studies and clinical evidence suggest that they might be used with an increased risk of intracranial hemorrhage. In this nested case-control study, we used Taiwan's nationwide universal health insurance database to investigate the possible association between statin therapy prescribed to acute ischemic stroke patients and their risk of subsequent intracerebral hemorrhage and all-cause mortality in Taiwan. Materials and Methods: All data were retrospectively obtained from Taiwan's National Health Insurance Research Database. Acute ischemic stroke patients were divided into a cohort receiving statin pharmacotherapy and a control cohort not receiving statin pharmacotherapy. A 1:1 matching for age, gender, and index day, and propensity score matching was conducted, producing 39,366 cases and 39,366 controls. The primary outcomes were long-term subsequent intracerebral hemorrhage and all-cause mortality. The competing risk between subsequent intracerebral hemorrhage and all-cause mortality was estimated using the Fine and Gray regression hazards model. Results: Patients receiving statin pharmacotherapy after an acute ischemic stroke had a significantly lower risk of subsequent intracerebral hemorrhage (p < 0.0001) and lower all-cause mortality rates (p < 0.0001). Low, moderate, and high dosages of statin were associated with significantly decreased risks for subsequent intracerebral hemorrhage (adjusted sHRs 0.82, 0.74, 0.53) and all-cause mortality (adjusted sHRs 0.75, 0.74, 0.74), respectively. Conclusions: Statin pharmacotherapy was found to safely and effectively reduce the risk of subsequent intracerebral hemorrhage and all-cause mortality in acute ischemic stroke patients in Taiwan.