Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

BackgroundIntracerebral hemorrhage (ICH) carries high risk for short‐term mortality. We sought to identify race‐specific predictors of mortality in ICH patients. Methods and ResultsWe used 2 databases, the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample (NIS). We included...

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Main Authors: Roland Faigle, Elisabeth B. Marsh, Rafael H. Llinas, Victor C. Urrutia, Rebecca F. Gottesman
Format: Article
Language:English
Published: Wiley 2016-08-01
Series:Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Subjects:
Online Access:https://www.ahajournals.org/doi/10.1161/JAHA.116.003540
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author Roland Faigle
Elisabeth B. Marsh
Rafael H. Llinas
Victor C. Urrutia
Rebecca F. Gottesman
author_facet Roland Faigle
Elisabeth B. Marsh
Rafael H. Llinas
Victor C. Urrutia
Rebecca F. Gottesman
author_sort Roland Faigle
collection DOAJ
description BackgroundIntracerebral hemorrhage (ICH) carries high risk for short‐term mortality. We sought to identify race‐specific predictors of mortality in ICH patients. Methods and ResultsWe used 2 databases, the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample (NIS). We included 226 patients with the primary diagnosis of spontaneous ICH from our stroke database between 2010 and 2013; in the NIS, 42 077 patients met inclusion criteria. Logistic regression was used to assess differences in predictors of mortality in blacks compared to whites. In our clinical stroke database, Glasgow Coma Scale (GCS; P=0.016), ICH volume (P=0.013), intraventricular haemorrhage (IVH; P=0.023), and diabetes mellitus (P=0.037) were predictors of mortality in blacks, whereas GCS (P=0.007), ICH volume (P=0.005), age (P=0.002), chronic kidney disease (P=0.003), and smoking (P=0.010) predicted mortality in whites. Among patients with IVH, blacks had over 7 times higher odds of mortality compared to whites (odds ratio [OR], 7.27; P value for interaction, 0.017) and were more likely to present with hydrocephalus (OR, 2.76; P=0.026). In the NIS, black ICH patients had higher rates of external ventricular drain (EVD) placement compared to whites (9.7% vs 5.0%; P<0.001) and were more likely to develop hydrocephalus (OR, 1.32; 95% CI, 1.20–1.46). Comparison of a race‐specific ICH score to the original ICH score showed that the various ICH score components have differential relevance for ICH score performance by race. ConclusionsIVH and age differentially predict mortality among blacks and whites. Blacks have higher rates of obstructive hydrocephalus and more frequently require EVD placement compared to their white counterparts.
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spelling doaj.art-2256aec7284344838b12c121199f60bb2022-12-21T18:11:22ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-08-015810.1161/JAHA.116.003540Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and WhitesRoland Faigle0Elisabeth B. Marsh1Rafael H. Llinas2Victor C. Urrutia3Rebecca F. Gottesman4Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MDDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MDDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MDDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MDDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MDBackgroundIntracerebral hemorrhage (ICH) carries high risk for short‐term mortality. We sought to identify race‐specific predictors of mortality in ICH patients. Methods and ResultsWe used 2 databases, the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample (NIS). We included 226 patients with the primary diagnosis of spontaneous ICH from our stroke database between 2010 and 2013; in the NIS, 42 077 patients met inclusion criteria. Logistic regression was used to assess differences in predictors of mortality in blacks compared to whites. In our clinical stroke database, Glasgow Coma Scale (GCS; P=0.016), ICH volume (P=0.013), intraventricular haemorrhage (IVH; P=0.023), and diabetes mellitus (P=0.037) were predictors of mortality in blacks, whereas GCS (P=0.007), ICH volume (P=0.005), age (P=0.002), chronic kidney disease (P=0.003), and smoking (P=0.010) predicted mortality in whites. Among patients with IVH, blacks had over 7 times higher odds of mortality compared to whites (odds ratio [OR], 7.27; P value for interaction, 0.017) and were more likely to present with hydrocephalus (OR, 2.76; P=0.026). In the NIS, black ICH patients had higher rates of external ventricular drain (EVD) placement compared to whites (9.7% vs 5.0%; P<0.001) and were more likely to develop hydrocephalus (OR, 1.32; 95% CI, 1.20–1.46). Comparison of a race‐specific ICH score to the original ICH score showed that the various ICH score components have differential relevance for ICH score performance by race. ConclusionsIVH and age differentially predict mortality among blacks and whites. Blacks have higher rates of obstructive hydrocephalus and more frequently require EVD placement compared to their white counterparts.https://www.ahajournals.org/doi/10.1161/JAHA.116.003540disparitieshydrocephalusintracerebral hemorrhageintraventricular hemorrhagemortalityprediction
spellingShingle Roland Faigle
Elisabeth B. Marsh
Rafael H. Llinas
Victor C. Urrutia
Rebecca F. Gottesman
Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
disparities
hydrocephalus
intracerebral hemorrhage
intraventricular hemorrhage
mortality
prediction
title Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites
title_full Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites
title_fullStr Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites
title_full_unstemmed Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites
title_short Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites
title_sort race specific predictors of mortality in intracerebral hemorrhage differential impacts of intraventricular hemorrhage and age among blacks and whites
topic disparities
hydrocephalus
intracerebral hemorrhage
intraventricular hemorrhage
mortality
prediction
url https://www.ahajournals.org/doi/10.1161/JAHA.116.003540
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