Quality of Life After Intracerebral Hemorrhage

Abstract

Neurological impairment and physical disability are frequent and important complications of stroke with serious consequences for health-related quality of life (HRQOL). Little data exist, however, on the risk factors for poor HRQOL after intracerebral hemorrhage, the deadliest and most disabling form of stroke. Factor Seven for Acute Hemorrhagic Stroke (FAST) was an international, randomized, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. All patients were followed for 3 months after stroke onset and HRQOL was assessed using the EuroQoL. Multivariate stepwise logistic regression was used to identify predictors of poor HRQOL based on demographic and clinical baseline characteristics and in-hospital complications. Six hundred fifty-seven patients survived until 3 months after stroke onset, and 621 (95%) completed the EuroQoL. Two percent had a utility score <0 (HRQOL worse than death), 15% a utility score <0.2, 32% a utility score <0.5, and 87% a score <0.87 (average score in the general population). At the other end of the scale, 13% had a utility score of 1 (perfect HRQOL). Independent predictors of poor HRQOL were advanced age (OR, 1.80; P<0.0001), higher baseline National Institutes of Health Stroke Scale score (OR, 1.11; P<0.0001), higher systolic blood pressure (OR, 1.05; P=0.0039), higher baseline intracerebral hemorrhage volume (OR, 1.11; P=0.015), deep (versus lobar) hematoma location (OR, 3.05; P=0.003), and increase in neurological deficit in first 72 hours after ICH onset (Delta Glasgow Coma Scale >or=2 or Delta National Institutes of Health Stroke Scale >or=4; OR, 2.04; P=0.006). The model explained a large amount of the variation in the utility score (C-statistic 0.77). The vast majority of survivors after intracerebral hemorrhage have very poor HRQOL. Critical care interventions designed to control blood pressure or prevent neuroworsening may improve HRQOL in intracerebral hemorrhage survivors.