Abstract 149: Trajectories Of Patient Centred, Cognitive And Functional Outcomes In Survivors Of Severe Intracerebral And Intraventricular Hemorrhage

Abstract

Objective: To describe trajectories of patient-centered, cognitive and functional outcomes and identify timepoints at which recovery plateaus after severe intracerebral and intraventricular hemorrhage (ICH/IVH). Methods: In this post-hoc analysis of CLEAR III and MISTIE III trials, all day-30 survivors were included (n=872). One-year trajectories of EuroQol 5-Dimensions (EQ5D), Visual Analog Scale (EQVAS), Mini Mental Status (MMSE), Barthel Index (BI), NIHSS and mRS were compared between patients with good (mRS0-3) vs. poor (mRS4-5) functional outcome at day-30, using mixed effects linear regression models. Results: Patients with good day-30 outcome (n=148), reported none to only moderate problems across all EQ5D dimensions. Mobility, selfcare and activity dimension mean scores improved significantly from day-30 to 180 (ß-slope, activity=-0.36, mobility=-0.25, selfcare=-0.27; all p<0.001), but did not improve from day-180 to 365 (all p>0.05). Contrarily, ICH/IVH survivors with poor day-30 outcome (n=724), reported extreme anxiety/depression, pain, inability to perform selfcare and usual activities at day-30, but, all mean scores improved significantly through 1-year (ß-slope for 1-year vs. day-30: mobility= -1.3; anxiety= -0.9, pain= -1.2; activities= -1.2; selfcare= -1.6; p<0.001). Likewise, significant cognitive recovery occurred through 1-year in poor day-30 outcome survivors (mean day-30 MMSE,11.5; ß-slope through 1-year=8.7, p<0.001), whereas good day-30 outcome survivors had peak cognitive recovery by day-180 (mean day-30 MMSE, 25; ß-slope=2.0, p<0.001). Similar trajectories were noted for EQVAS and other outcomes. The gap across all domains between survivors with good versus poor day-30 outcome narrowed significantly by one-year, but mean scores remained different between the two groups. Conclusion: In addition to functional disability, severe ICH/IVH survivors have significant anxiety, depression, pain, cognitive impairment and inability to perform selfcare or usual activities in the early phase, all of which improve significantly over time. While patients with early functional recovery plateau by 6-months, those with severe disability at day-30 continue to improve across all domains through 1-year.