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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Format: | Article |
Language: | English |
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Wiley
2016-08-01
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Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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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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institution | Directory Open Access Journal |
issn | 2047-9980 |
language | English |
last_indexed | 2024-12-22T21:50:46Z |
publishDate | 2016-08-01 |
publisher | Wiley |
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series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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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