The Effect of Age on Characteristics and Mortality of Intracerebral Hemorrhage in the Oldest-Old

Autor: Michele Domenico Spampinato, Maura Coveri, Luigi Simonetti, Marco Zoli, Fabiola Maioli, Paola Forti, Valeria Nativio, Giuseppe Di Pasquale, Carlotta Barbara, Gaetano Procaccianti
Přispěvatelé: Forti, Paola, Maioli, Fabiola, Domenico Spampinato, Michele, Barbara, Carlotta, Nativio, Valeria, Coveri, Maura, Zoli, Marco, Simonetti, Luigi, Di Pasquale, Giuseppe, Procaccianti, Gaetano
Rok vydání: 2016
Předmět:
Male
Pediatrics
Time Factors
030204 cardiovascular system & hematology
Patient Admission
0302 clinical medicine
Primary intracerebral hematoma
Risk Factors
Stroke
Stroke in the elderly
Aged
80 and over
Hematoma
Incidence
Incidence (epidemiology)
Confounding
Middle Aged
Incidence and mortality rate
Prognosis
Italy
Neurology
Female
Medical emergency
Cohort study
Cardiology and Cardiovascular Medicine
Adult
medicine.medical_specialty
03 medical and health sciences
Age Distribution
medicine
Humans
Glasgow Coma Scale
cardiovascular diseases
Aged
Cerebral Hemorrhage
Proportional Hazards Models
Retrospective Studies
Intracerebral hemorrhage
Chi-Square Distribution
business.industry
Proportional hazards model
medicine.disease
nervous system diseases
Logistic Models
Multivariate Analysis
Linear Models
Neurology (clinical)
Tomography
X-Ray Computed
business
030217 neurology & neurosurgery
Zdroj: Cerebrovascular Diseases. 42:485-492
ISSN: 1421-9786
1015-9770
Popis: Background: Incidence of acute intracerebral hemorrhage (ICH) increases with age, but there is a lack of information about ICH characteristics in the oldest-old (age ≥85 years). In particular, there is a need for information about hematoma volume, which is included in most clinical scales for prediction of mortality in ICH patients. Many of these scales also assume that, independent of ICH characteristics, the oldest-old have a higher mortality than younger elderly patients (age 65-74 years). However, supporting evidence from cohort studies is limited. We investigated ICH characteristics of oldest-old subjects compared to young (Methods: We retrospectively collected clinical and neuroimaging data of 383 subjects (age 34-104 years) with acute supratentorial primary ICH who were admitted to an Italian Stroke Unit (SU) between October 2007 and December 2014. Measured ICH characteristics included hematoma location, volume and intraventricular extension of hemorrhage on admission CT scan; admission Glasgow Coma Scale ≤8 and hematoma expansion (HE) measured on follow-up CT-scans obtained after 24 h. General linear models and logistic models were used to investigate the association of age with ICH characteristics. These models were adjusted for pre-admission characteristics, hematoma location and time from symptom onset to admission CT scan. Limited to elderly subjects, Cox models were used to investigate the association of age with in-SU and 1-year mortality: the model for in-SU mortality adjusted for pre-admission and ICH admission characteristics and the model for 1-year mortality additionally adjusted for functional status and disposition at SU discharge. Results: Independent of pre-admission characteristics, hematoma location and time from symptom onset to admission CT-scan, oldest-old subjects had the highest admission hematoma volume (p < 0.01). Age was unrelated to all other ICH characteristics including HE. In elderly patients, multivariable adjusted risk of in-SU and 1-year mortality did not vary across age categories. Conclusions: Oldest-old subjects with acute supratentorial ICH have higher admission hematoma volume than young and young-old subjects but do not differ for other ICH characteristics. When taking into account confounding from ICH characteristics, risk of in-SU and 1-year mortality in elderly subjects with acute supratentorial ICH does not differ across age categories. Our findings question use of age as an independent criterion for stratification of mortality risk in elderly subjects with acute ICH.
Databáze: OpenAIRE
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