Intracerebral hemorrhage location and outcome among INTERACT2 participants.

Shihong Zhang,Danni Zheng,Richard I Lindley,John Chalmers,Candice Delcourt,For The Interact2 Investigators ,Maree L Hackett,Xiaoying Chen,Emma Heeley,Thompson Robinson,Else Charlotte Sandset,Leo Davies,Pablo M Lavados,Shoichiro Sato,Hisatomi Arima,Rustam Al-Shahi Salman,Jun Hata,Christian Stapf,Craig S Anderson

doi:10.1212/wnl.0000000000003771

Abstract

Objective:To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).Methods:Associations between ICH sites and poor outcomes (death [6] or major disability [3–5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models.Results:Of 2,066 patients included in the analyses, associations were identified between ICH sites and poor outcomes: involvement of posterior limb of internal capsule increased risks of death or major disability (odds ratio [OR] 2.10) and disability (OR 1.81); thalamic involvement increased risks of death or major disability (OR 2.24) and death (OR 1.97). Involvement of the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor EQ-5D utility score (≤0.7 [median]; OR 1.87, 2.14, and 2.81, respectively). Posterior limb of internal capsule involvement was strongly associated with low scores across all health-related quality of life domains. ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability, major disability, and poor EQ-5D utility score (OR 1.72, 2.26, and 1.71, respectively).Conclusion:Poor clinical outcomes are related to ICH affecting the posterior limb of internal capsule, thalamus, and infratentorial sites. The highest association with death or major disability and poor EQ-5D utility score was seen in ICH encompassing the thalamus and posterior limb of internal capsule.ClinicalTrials.gov registration:NCT00716079.

Highlights

Poor clinical outcomes are related to intracerebral hemorrhage (ICH) affecting the posterior limb of internal capsule, thalamus, and infratentorial sites
After adjustment for potential confounders, ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability and major disability (2.26 [1.58–3.23])
ICH involving the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor health-related quality of life (HRQoL)

Summary

Methods

Associations between ICH sites and poor outcomes (death [6] or major disability [3–5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models. The INTERACT2 study was a randomized, open, multicenter, controlled trial with blinded outcome assessment conducted between 2008 and 2012.6 A total of 2,839 patients with imaging-confirmed ICH were randomly assigned to receive either early intensive blood pressure (BP)– lowering treatment (,140 mm Hg systolic BP goal) or the contemporaneous guideline-recommended BP management (,180 mm Hg systolic BP goal) within 6 hours of onset. The study protocol was approved by the appropriate ethics committee at each participating site, and written informed consent was obtained from patients or appropriate surrogates.

Results

Discussion

Conclusion