Temporal trends in intracerebral hemorrhage: Evidence from the Austrian Stroke Unit Registry

Autoři: Christoph Schellen aff001;  Alexandra Posekany aff002;  Julia Ferrari aff003;  Stefan Krebs aff003;  Wilfried Lang aff003;  Michael Brainin aff002;  Dimitre Staykov aff005;  Marek Sykora aff003
Působiště autorů: Department of Radiology, Rudolf Foundation Hospital ("Krankenanstalt Rudolfstiftung"), Vienna, Austria aff001;  Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria aff002;  Department of Neurology, St. John's Hospital, Vienna, Austria aff003;  Medical Faculty, Sigmund Freud University, Vienna, Austria aff004;  Department of Neurology, St. John's Hospital, Eisenstadt, Austria aff005;  I. Department of Neurology, Comenius University, Bratislava, Slovakia aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225378



To assess changes in frequency, severity, complications, therapy and outcome of intracerebral hemorrhage in patients treated in stroke units in Austria, we evaluated data from the Austrian Stroke Unit Registry between 2008 and 2016.

Methods and findings

Data of 6707 cases of ICH covering a time span of 9 years and including information on age, risk factors, pre-stroke modified Rankin Score (mRS), baseline stroke severity (NIHSS), complications, therapy, functional outcome, and mortality were extracted from the Austrian Stroke Unit Registry. A multivariate regularized logistic regression model and linear models for temporal dependence were computed for analyzing statistical inference and time trends. Bonferroni correction was applied to correct for multiple testing.

Between 2008 and 2016, the proportion of ICH admissions to stroke units in Austria declined, with a shift among patients towards older age (>70 years, p = 0.04) and lower admission NIHSS scores. While no significant time trends in risk factors, pre-stroke mRS and medical complications were observed, therapeutic interventions declined significantly (p<0.001). Three-month mortality increased over the years independently (p = 0.003).


Despite declining incidence and clinical severity of ICH we observed a clear increase in three-month mortality. This effect seems to be independent of predictors including age, admission NIHSS, pre-morbid MRS, or medical complications. The observations from this large retrospective database cohort study underline an urgent call for action in the therapy of ICH.

Klíčová slova:

Death rates – Hemorrhagic stroke – Intravenous injections – Intubation – Medical risk factors – stroke – Antihypertensive drug therapy


1. Zahuranec DB, Lisabeth LD, Sánchez BN, Smith MA, Brown DL, Garcia NM, et al. Intracerebral hemorrhage mortality is not changing despite declining incidence. Neurology. 2014 Jun 17;82(24):2180–6. doi: 10.1212/WNL.0000000000000519 24838789

2. Béjot Y, Grelat M, Delpont B, Durier J, Rouaud O, Osseby G-V, et al. Temporal trends in early case-fatality rates in patients with intracerebral hemorrhage. Neurology. 2017 Mar 7;88(10):985–90. doi: 10.1212/WNL.0000000000003681 28159886

3. Otite FO, Khandelwal P, Malik AM, Chaturvedi S, Sacco RL, Romano JG. Ten-Year Temporal Trends in Medical Complications After Acute Intracerebral Hemorrhage in the United States. Stroke. 2017 Mar;48(3):596–603. doi: 10.1161/STROKEAHA.116.015746 28228576

4. Siddiqui AA, Siddiqui JS, Wasay M, Azam SI, Ahmed A. A Dynamical Study of Risk Factors in Intracerebral Hemorrhage using Multivariate Approach. Int J Stat Med Res. 2013;2(1):23–33.

5. Tsivgoulis G, Patousi A, Pikilidou M, Birbilis T, Katsanos AH, Mantatzis M, et al. Stroke Incidence and Outcomes in Northeastern Greece: The Evros Stroke Registry. Stroke. 2018 Feb;49(2):288–95. doi: 10.1161/STROKEAHA.117.019524 29335330

6. Gattellari M, Goumas C, Worthington J. Declining rates of fatal and nonfatal intracerebral hemorrhage: epidemiological trends in Australia. J Am Heart Assoc. 2014 Dec 8;3(6):e001161. doi: 10.1161/JAHA.114.001161 25488294

7. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010 Feb;9(2):167–76. doi: 10.1016/S1474-4422(09)70340-0 20056489

8. Kleindorfer DO, Khoury J, Moomaw CJ, Alwell K, Woo D, Flaherty ML, et al. Stroke incidence is decreasing in whites but not in blacks: A population-based estimate of temporal trends in stroke incidence from the greater cincinnati/northern kentucky stroke study. Stroke. 2010;41(7):1326–31. doi: 10.1161/STROKEAHA.109.575043 20489177

9. Islam MS, Anderson CS, Hankey GJ, Hardie K, Carter K, Broadhurst R, et al. Trends in incidence and outcome of stroke in Perth, Western Australia during 1989 to 2001: the Perth Community Stroke Study. Stroke. 2008 Mar;39(3):776–82. doi: 10.1161/STROKEAHA.107.493643 18239179

10. Wasay M, Khatri IA, Khealani B, Afaq M. Temporal trends in risk factors and outcome of intracerebral hemorrhage over 18 years at a tertiary care hospital in Karachi, Pakistan. J Stroke Cerebrovasc Dis. 2012 May;21(4):289–92. doi: 10.1016/j.jstrokecerebrovasdis.2010.09.001 20970357

11. Guéniat J, Brenière C, Graber M, Garnier L, Mohr S, Giroud M, et al. Increasing Burden of Stroke: The Dijon Stroke Registry (1987–2012). Neuroepidemiology. 2018 Feb 1;50(1–2):47–56. doi: 10.1159/000486397 29393231

12. Jolink WMT, Klijn CJM, Brouwers PJAM, Kappelle LJ, Vaartjes I. Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage. Neurology. 2015 Oct 13;85(15):1318–24. doi: 10.1212/WNL.0000000000002015 26377254

13. Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet. 2004;363(9425):1925–33. doi: 10.1016/S0140-6736(04)16405-2 15194251

14. Hofer C, Kiechl S, Lang W. [The Austrian Stroke-Unit-Registry]. Wien Med Wochenschr. 2008;158(15–16):411–7. doi: 10.1007/s10354-008-0563-6 18766309

15. Brainin M, Lang W. Editorial: Stroke units in Austria: structure, performance and results. Wien Med Wochenschr. 2008;158(15–16):407–8, 408–10. doi: 10.1007/s10354-008-0562-7 18766308

16. Ferrari J, Knoflach M, Kiechl S, Willeit J, Schnabl S, Seyfang L, et al. Early clinical worsening in patients with TIA or minor stroke: the Austrian Stroke Unit Registry. Neurology. 2010 Jan 12;74(2):136–41. doi: 10.1212/WNL.0b013e3181c9188b 20065248

17. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria; 2018. Available from: https://www.r-project.org

18. Knoflach M, Matosevic B, Rücker M, Furtner M, Mair A, Wille G, et al. Functional recovery after ischemic stroke–a matter of age: data from the Austrian Stroke Unit Registry. Neurology. 2012 Jan 24;78(4):279–85. doi: 10.1212/WNL.0b013e31824367ab 22238419

19. Teuschl Y, Brainin M, Matz K, Dachenhausen A, Ferrari J, Seyfang L, et al. Time trends in patient characteristics treated on acute stroke-units: results from the Austrian Stroke Unit Registry 2003–2011. Stroke. 2013 Apr;44(4):1070–4. doi: 10.1161/STROKEAHA.111.676114 23412371

20. Béjot Y, Cordonnier C, Durier J, Aboa-Eboulé C, Rouaud O, Giroud M. Intracerebral haemorrhage profiles are changing: results from the Dijon population-based study. Brain. 2013 Feb;136(Pt 2):658–64. doi: 10.1093/brain/aws349 23378220

21. Zahuranec DB, Brown DL, Lisabeth LD, Gonzales NR, Longwell PJ, Smith MA, et al. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology. 2007 May 15;68(20):1651–7. doi: 10.1212/01.wnl.0000261906.93238.72 17502545

22. Becker KJ, Baxter AB, Cohen WA, Bybee HM, Tirschwell DL, Newell DW, et al. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology. 2001 Mar 27;56(6):766–72. doi: 10.1212/wnl.56.6.766 11274312

23. Geurts M, de Kort FA, de Kort PL, van Tuijl JH, van Thiel GJ, Kappelle LJ, et al. Treatment restrictions in patients with severe stroke are associated with an increased risk of death. Eur Stroke J. 2017 Sep 28;2(3):244–9. doi: 10.1177/2396987317704546 29900408

24. Morgenstern LB, Zahuranec DB, Sánchez BN, Becker KJ, Geraghty M, Hughes R, et al. Full medical support for intracerebral hemorrhage. Neurology. 2015 Apr 28;84(17):1739–44. doi: 10.1212/WNL.0000000000001525 25817842

25. Silvennoinen K, Meretoja A, Strbian D, Putaala J, Kaste M, Tatlisumak T. Do-not-resuscitate (DNR) orders in patients with intracerebral hemorrhage. Int J Stroke. 2014 Jan;9(1):53–8. doi: 10.1111/ijs.12161 24148872

26. Langhorne P, Fearon P, Ronning OM, Kaste M, Palomaki H, Vemmos K, et al. Stroke unit care benefits patients with intracerebral hemorrhage: systematic review and meta-analysis. Stroke. 2013 Nov;44(11):3044–9. doi: 10.1161/STROKEAHA.113.001564 24065713

Článek vyšel v časopise


2019 Číslo 11