Risk Factor For Intracerebral Hemorrhage Research Articles

Risk Factors for Intracerebral Hemorrhage: Genome-Wide Association Study and Mendelian Randomization Analyses.

The genetic and nongenetic causes of intracerebral hemorrhage (ICH) remain obscure. The present study aimed to uncover the genetic and modifiable risk factors for ICH. We meta-analyzed genome-wide association study data from 3 European biobanks, involving 7605 ICH cases and 711 818 noncases, to identify the genomic loci linked to ICH. To uncover the potential causal associations of cardiometabolic and lifestyle factors with ICH, we performed Mendelian randomization analyses using genetic instruments identified in previous genome-wide association studies of the exposures and ICH data from the present genome-wide association study meta-analysis. We performed multivariable Mendelian randomization analyses to examine the independent associations of the identified risk factors with ICH and evaluate potential mediating pathways. We identified 1 ICH risk locus, located at the APOE genomic region. The lead variant in this locus was rs429358 (chr19:45411941), which was associated with an odds ratio of ICH of 1.17 (95% CI, 1.11-1.20; P=6.01×10-11) per C allele. Genetically predicted higher levels of body mass index, visceral adiposity, diastolic blood pressure, systolic blood pressure, and lifetime smoking index, as well as genetic liability to type 2 diabetes, were associated with higher odds of ICH after multiple testing corrections. Additionally, a genetic increase in waist-to-hip ratio and liability to smoking initiation were consistently associated with ICH, albeit at the nominal significance level (P<0.05). Multivariable Mendelian randomization analysis showed that the association between body mass index and ICH was attenuated on adjustment for type 2 diabetes and further that type 2 diabetes may be a mediator of the body mass index-ICH relationship. Our findings indicate that the APOE locus contributes to ICH genetic susceptibility in European populations. Excess adiposity, elevated blood pressure, type 2 diabetes, and smoking were identified as the chief modifiable cardiometabolic and lifestyle factors for ICH.

Key Risk Factors for Intracerebral Hemorrhage According to Regional Population-Based Stroke Registry

Introduction. Intracerebral hemorrhage (ICH) registry data allow assessing epidemiological parameters and risk factors in different age, gender, race, ethnicity, and other subgroups.&#x0D; This study aimed to evaluate the prevalence of key risk factors in a group of Yakutsk residents with primary hypertensive ICH included in the regional population-based stroke registry from 2015 to 2017.&#x0D; Materials and methods. This study of risk factors was conducted in patients with hypertensive ICH (n = 251) from the regional population-based stroke registry, including 133 (53%) men and 118 (47%) women of Asian or Caucasian races. We performed statistical analysis of data.&#x0D; Results. The analysis of risk factors showed that the prevalence of smoking and excessive alcohol consumption was higher in men with ICH compared with women (p 0.001). There were no statistically significant differences in the incidence of hypertension, history of myocardial infarction, dyslipidemia, or diabetes mellitus in patients with ICH in gender or ethnicity subgroups. Fibrillation and other heart diseases were more common in Caucasian patients than in Asian (p = 0.005). ICH was associated with high levels of low-density lipoproteins and triglycerides with low levels of total cholesterol and high-density lipoproteins compared with healthy individuals.&#x0D; Conclusions. We described gender and ethnic differences in the prevalence of risk factors in patients with hypertensive ICH.

IJCM_339A: Risk Factors for Spontaneous Intracerebral Haemorrhage in Tertiary Care Hospitals of Mangalore: A Case Control Study

Background: Intracerebral haemorrhage (ICH) is the rupture of an intra- parenchymal vessel resulting in haemorrhage within the brain, often associated with stroke. The study was done to determine the association of intracerebral haemorrhage with duration of hypertension and other lifestyle factors among the adult patients. The study also includes association of the volume of ICH and its determinants related to hypertension. Methodology: A Record based Case Control study with cases involving the patient with ICH admitted to study hospital between January 1st 2014 and 31st December 2015 and control involving age and sex matched patients admitted during the study period. Results: Of the 118 patients, 41 cases (69.5%) and 12 controls (20.3%) had hypertension, with odds ratio 8.93. 40% of cases were suffering from hypertension for 5 years. 18.6% of ICH patients gave history of tobacco consumption and 30.5% gave history of alcohol consumption. 57.2% and 60% of ICH patients consumed tobacco and alcohol for more than 10 years respectively. Mean volume of intracerebral bleed in patients with hypertension is 12.4ml and without hypertension is 3.45ml. 23 patients had systolic BP more than 140mm of Hg and an average bleed of 10.33ml. Conclusion: ICH is the second commonest type of stroke, ischemic being the first one. Hypertension is the risk factor for ICH. Volume of bleed was higher among the patient who were hypertensive for longer duration and who had increased systolic BP.

Risk factors for intracerebral hemorrhage in small-vessel disease and non-small-vessel disease etiologies-an observational proof-of-concept study.

Sporadic cerebral small-vessel disease (CSVD), i.e., hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA), is the main cause of spontaneous intracerebral hemorrhage (ICH). Nevertheless, a substantial portion of ICH cases arises from non-CSVD etiologies, such as trauma, vascular malformations, and brain tumors. While studies compared HA- and CAA-related ICH, non-CSVD etiologies were excluded from these comparisons and are consequently underexamined with regard to additional factors contributing to increased bleeding risk beyond their main pathology. As a proof of concept, we conducted a retrospective observational study in 922 patients to compare HA, CAA, and non-CSVD-related ICH with regard to factors that are known to contribute to spontaneous ICH onset. Medical records (available for n = 861) were screened for demographics, antithrombotic medication, and vascular risk profile, and CSVD pathology was rated on magnetic resonance imaging (MRI) in a subgroup of 185 patients. The severity of CSVD was assessed with a sum score ranging from 0 to 6, where a score of ≥2 was defined as advanced pathology. In 922 patients with ICH (median age of 71 years), HA and CAA caused the majority of cases (n = 670, 73%); non-CSVD etiologies made up the remaining quarter (n = 252, 27%). Individuals with HA- and CAA-related ICH exhibited a higher prevalence of predisposing factors than those with non-CSVD etiologies. This includes advanced age (median age: 71 vs. 75 vs. 63 years, p < 0.001), antithrombotic medication usage (33 vs. 37 vs. 19%, p < 0.001), prevalence of vascular risk factors (70 vs. 67 vs. 50%, p < 0.001), and advanced CSVD pathology on MRI (80 vs. 89 vs. 51%, p > 0.001). However, in particular, half of non-CSVD ICH patients were either aged over 60 years, presented with vascular risk factors, or had advanced CSVD on MRI. Risk factors for spontaneous ICH are less common in non-CSVD ICH etiologies than in HA- and CAA-related ICH, but are still frequent. Future studies should incorporate these factors, in addition to the main pathology, to stratify an individual's risk of bleeding.

APOE ε4 and Intracerebral Hemorrhage in Patients With Brain Arteriovenous Malformation

Intracerebral hemorrhage (ICH) is a serious complication of brain arteriovenous malformation (AVM). Apolipoprotein E (APOE) ε4 is a well-known genetic risk factor for ICH among persons without AVM, and cerebral amyloid angiopathy is a vasculopathy frequently observed in APOE ε4 carriers that may increase the risk of ICH. To assess whether APOE ε4 is associated with a higher risk of ICH in patients with a known AVM. This cross-sectional study including 412 participants was conducted in 2 stages (discovery and replication) using individual-level data from the UK Biobank (released March 2012 and last updated October 2023) and the All of Us Research Program (commenced on May 6, 2018, with its latest update provided in October 2023). The occurrence of AVM and ICH was ascertained at the time of enrollment using validated International Classification of Diseases, Ninth Revision and Tenth Revision, codes. Genotypic data on the APOE variants rs429358 and rs7412 were used to ascertain the ε status. For each study, the association between APOE ε4 variants and ICH risk was assessed among patients with a known AVM by using multivariable logistic regression. The discovery phase included 253 UK Biobank participants with known AVM (mean [SD] age, 56.6 [8.0] years, 119 [47.0%] female), of whom 63 (24.9%) sustained an ICH. In the multivariable analysis of 240 participants of European ancestry, APOE ε4 was associated with a higher risk of ICH (odds ratio, 4.58; 95% CI, 2.13-10.34; P < .001). The replication phase included 159 participants with known AVM enrolled in All of Us (mean [SD] age, 57.1 [15.9] years; 106 [66.7%] female), of whom 29 (18.2%) sustained an ICH. In multivariable analysis of 101 participants of European ancestry, APOE ε4 was associated with higher risk of ICH (odds ratio, 4.52; 95% CI, 1.18-19.38; P = .03). The results of this cross-sectional study of patients from the UK Biobank and All of Us suggest that information on APOE ε4 status may help identify patients with brain AVM who are at particularly high risk of ICH and that cerebral amyloid angiopathy should be evaluated as a possible mediating mechanism of the observed association.

Abstract WP213: Exploring Contrast Extravasation and Associated Variables in Acute Ischemic Stroke Patients After Mechanical Thrombectomy: Single Center Experience

Introduction: Head CT hyperdensity (HCH) commonly follows mechanical thrombectomy (MT) for large vessel occlusion (LVO), often due to contrast extravasation (CE) or intracerebral hemorrhage (ICH). Given the 20-88% prevalence in studies, understanding associated variables is crucial for outcomes. Risk factors for ICH after MT are studied, but CE understanding is lacking. We investigated CE occurrence variables and their impact on outcomes. Methods: We retrospectively analyzed data from 164 patients (mean age 65 years, 51% men, 59% White) with LVO who underwent MT in our center (between 2019-2022) with initial and repeat post-MT CT scans within a 24-hour window. CE was defined as the disappearance or reduction of HCH on repeat CT within 24 hours; those with both CE and ICH were excluded. We investigated demographic information, risk factors, lab values, procedural, and neurological outcome data. Parametric and non-parametric tests compared variables between CE and ICH. Adjusted odds ratios (aOR) were computed through multivariate logistic regression to evaluate the association of CE with the variables. Results: HCH was reported in 56.1% (92 out of 164) of patients in our cohort. CE and ICH were detected in 34 (20.4%) and 58 (35.4%) patients. In unadjusted models, our patients with CE had higher low-density lipoprotein (LDL) levels (111 mg/dL vs. 80 mg/dL, p=0.04) and lower complete reperfusion score (29.4% vs. 55.2%, p=0.02) (Table 1). Multivariate logistic regression analysis demonstrated a higher aOR (1.03, 95%CI 1-1.06, p=0.03) of LDL in patients with CE (Table 2). Conclusion: Our findings revealed a notable association between CE and higher LDL levels. Elevated LDL levels are often linked to systemic inflammation, endothelial dysfunction, vascular changes, and disruptions in the blood-brain barrier, increasing the likelihood of CE. This association prompts further investigation into the underlying pathophysiology of CE.

Abstract WP160: Mechanisms of Brain Hemorrhage in Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is a risk factor for intracerebral hemorrhage (ICH) and for worse outcomes following ICH. In this study, we examined the relationship between ICH and CKD, as well as intracranial arterial calcification (IAC) as an intermediate biomarker. We hypothesized that CKD is an independent risk factor for IAC burden, and that high IAC burden is an independent risk factor for ICH. Methods: A retrospective cohort of spontaneous ICH and non-ICH patients with non-contrast head CT imaging was identified. For each patient, eGFR (estimated glomerular filtration rate) along with age, sex, race, ethnicity, hypertension (HTN), diabetes (DM), heart disease, and hyperlipidemia were abstracted. A convolutional neural network was developed to automate quantification of IAC burden within the anterior and posterior circulation, and all results were visually verified for accuracy by an expert neuroradiologist. The relationship between eGFR and IAC was assessed with Pearson correlation and one-way ANOVA. Univariate analysis of ICH risk factors was evaluated using t-test and Chi-square, while multivariate models were analyzed using logistic regression. Results: Among the 717 patients in this study, 98 were ICH patients. In all patients, mean IAC burden increased significantly with CKD stage (p &lt; 0.01). Univariate analysis for IAC risk factors yielded statistically significant associations for eGFR (p &lt; 0.01) as well as age (p &lt; 0.01), HTN (p = 0.01), and African-American race (p = 0.02). In multivariate analysis, eGFR remained a significant independent predictor of IAC (p &lt; 0.01) along with HTN (p &lt; 0.01), DM (p &lt; 0.01), and race (p &lt; 0.01). Furthermore, IAC burden was significantly higher in ICH patients (15.4 mL vs. 8.7 mL, p = 0.02). In multivariate analysis, IAC remained a significant independent predictor of ICH (p &lt; 0.01) along with HTN (p &lt; 0.01), DM (p = 0.03), sex (p &lt; 0.01), and race (p &lt; 0.01). Conclusion: This is the first demonstration that eGFR predicts strictly quantified IAC, which then predicts ICH. These findings offer novel insights into determinants of IAC and mechanisms underlying the CKD-ICH relationship.

Clinical and molecular determinants of bleeding-related adverse outcomes in high-grade glioma.

Cancer is an independent risk factor for the development of venous thromboembolism (VTE). However, patients with high-grade glioma (HGG) including glioblastoma (GBM) are at a particularly high risk of VTE with an incidence up to 20-30% per year. Patients are often placed on anticoagulation if they are found to have VTE. However, patients with primary brain tumors such as HGG are at increased risk for intracerebral hemorrhage (ICH) even without the administration of anticoagulation. The combination of risk factors for ICH with anticoagulation and HGG complicates decision-making. Currently it is not known which of the direct oral anticoagulants (DOACs) are safest for patients with HGG in terms of adverse bleeding-related outcomes such as ICH. Furthermore, a deeper understanding of the clinical and molecular determinants of bleeding-related adverse outcomes in HGG is not fully characterized. In this retrospective study, we identified and gathered data on 75 consecutive patients with pathology-confirmed HGG with hospital encounters at two academic medical center hospitals in Austin between July 1, 2017 and June 30, 2022. We compared clinical and treatment-related factors among cohorts who had received various forms of anticoagulation or no anticoagulation. Patients who were on rivaroxaban (3/7 (43%)) had a statistically significant association with more bleeding-related adverse events compared to those on apixaban (0/12 (0%)) or enoxaparin (0/5 (0%), p = 0.022) even though the groups were similar in characteristics including total time on the respective anticoagulation. Patients on anticoagulation vs those never on anticoagulation did not differ in terms of their studied demographic and clinical characteristics. Intriguingly, logistic regression analysis revealed that patients Astrocytoma, isocitrate dehydrogenase (IDH) mutant, grade 4 had a significant association with more adverse bleeding-related events even when controlling for other relevant factors (Odds Ratio compared to reference GBM: 49.4, 95% CI: 2.8, 2084.7; p = 0.013). In this study we found that the use of rivaroxaban was associated with more bleeding-related events compared to apixaban and enoxaparin in patients with high-grade glioma. In this study we also found that the diagnosis of astrocytoma, IDH mutant, grade 4 was associated with more bleeding events. However, this is based on a small study and there is a need for larger studies to further evaluate these results.

Predictors and Outcomes of Acute Brain Injury in Patients on Venoarterial Extracorporeal Membrane Oxygenation after Cardiopulmonary Resuscitation.

Venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) after cardiac arrest often predisposes patients to acute brain injury (ABI), which affects survival and neurological performance. The investigation of the predictors of ABI will be beneficial for further management. To explore the predictors and outcomes of ABI and intracerebral hemorrhage (ICH) in patients experiencing cardiac arrest and cardiopulmonary resuscitation (CPR) with V-A ECMO support. We retrospectively analyzed 150 patients who successfully weaned from V-A ECMO support after pre-ECMO CPR at our institution from January 2009 to December 2021. Short-term and long-term outcomes were evaluated. Characteristics before and during ECMO were analyzed for determining the predictors of ABI and ICH. Of the 150 patients, 66 (44.0%) had ABI. ABI was associated with higher in-hospital mortality (62.1% vs. 21.4%, p < 0.0001) and poorer long-term survival after discharge (p = 0.002). Patients who survived to discharge with ABI had significantly more severe neurological deficits at discharge (84.0% vs. 42.4%, p < 0.0001) and improved little at one year after discharge (33.3% vs. 11.4%, p = 0.027). We found that CPR duration [odds ratio (OR) = 1.04, p = 0.003] was the independent risk factor for ABI, whereas lower platelet counts was the independent risk factor for ICH (OR = 0.96, p = 0.019). After CPR, development of ABI during V-A ECMO support impacted survival and further neurological outcome. Longer CPR duration before ECMO set up significantly increases the occurrence of ABI. Besides, severe thrombocytopenia during ECMO support increases the possibility of ICH.

Association between subconjunctival hemorrhage and hemorrhagic disorders: a nationwide population-based study

Subconjunctival hemorrhage (SCH) is a benign eye condition that is often noticeable and leads to medical attention. Despite previous studies investigating the relationship between SCH and cardiovascular diseases, the relationship between SCH and bleeding disorders remains controversial. In order to gain further insight into this association, a nationwide cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort version 2.0 from 2006 to 2015. The study defined SCH using a diagnostic code and compared the incidence and risk factors of intracerebral hemorrhage (ICH) and gastrointestinal (GI) bleeding in 36,772 SCH individuals and 147,088 propensity score (PS)-matched controls without SCH. The results showed that SCH was associated with a lower risk of ICH (HR = 0.76, 95% CI = 0.622–0.894, p = 0.002) and GI bleeding (HR = 0.816, 95% CI = 0.690–0.965, p = 0.018) when compared to the PS-matched control group. This reduced risk was more pronounced in females and in the older age group (≥ 50 years), but not observed in males or younger age groups. In conclusion, SCH dose not increase the risk of ICH and major GI bleeding and is associated with a decreased incidence in females and individuals aged ≥ 50 years.

EPID-08. CLINICAL AND MOLECULAR DETERMINANTS OF BLEEDING-RELATED ADVERSE OUTCOMES IN HIGH-GRADE GLIOMA

Abstract Cancer is an independent risk factor for the development of venous thromboembolism (VTE) however patients with high-grade glioma (HGG) including glioblastoma (GBM) are at a particularly high risk of VTE with an incidence up to 20- 30% per year. Patients are often placed on anticoagulation to reduce the risk of VTE. However, patients with primary brain tumors such as HGG are at increased risk for intracerebral hemorrhage (ICH) even without the administration of anticoagulation. The combination of risk factors for ICH with anticoagulation and HGG complicates decision-making. Currently it is not known which of the direct oral anticoagulants (DOACs) are safest for patients with HGG in terms of adverse bleeding-related outcomes such as ICH. Furthermore, a deeper understanding of the clinical and molecular determinants of bleeding-related adverse outcomes in HGG is not fully characterized. In this study, we gathered data on patients with HGG from two Ascension Seton Hospitals in the Austin metro area from July 1, 2017 through June 30, 2022. We identified 76 pathology-confirmed patients with HGG. Patients who were on rivaroxaban (3/7 (43%), p=.022) had a statistically significant association with more bleeding-related adverse events compared to those on apixaban (0/12 (0%)) or enoxaparin (0/5 (0%)) even though the groups were similar in terms of their characteristics including total time on the respective anticoagulation. Patients on anticoagulation vs those never on anticoagulation did not differ in terms of their studied demographic and clinical characteristics. Intriguingly, logistic regression analysis revealed that patients harboring isocitrate dehydrogenase (IDH) mutations had a statistically significant association with more adverse bleeding-related events even when controlling for other relevant factors (Odds Ratio compared to reference GBM: 115.7; p=.014). This study offers insights into our understanding of relevant factors associated with worse bleeding-related adverse outcomes such as ICH in patients with HGG.

Intracerebral hemorrhage mortality in individuals with atrial fibrillation: a nationwide analysis of mortality trends in the United States.

Atrial fibrillation (AF) is a risk factor for intracerebral hemorrhage (ICH), both with and without use of anticoagulation. Limited data exists on mortality trends and disparities related to this phenomenon. We aimed to assess ICH mortality trends and disparities based on demographic factors in individuals with atrial fibrillation in the United States (US). Our cross-sectional analysis utilized mortality data from the CDC database through death certificate queries from the years 1999 to 2020 in the US. We queried for all deaths with ICH as the underlying cause of death and atrial fibrillation as the multiple causes of death. Mortality data was obtained for overall population and demographic subpopulations based on sex, race and ethnicity, and geographic region. Trend analysis and average annual-mortality percentage change (AAPC) were completed using log-linear regression models. ICH age-adjusted mortality rate (AAMR) in patients with AF increased from 0.27 (95% CI 0.25-0.29) in 1999 to 0.30 (95% CI 0.29-0.32) in 2020. A higher mortality rate was observed in males (AAMR 0.33) than in females (AAMR 0.26). The highest mortality was found in Asian/Pacific Islander (AAMR: 0.32) populations, followed by White (AAMR: 0.30), Black (AAMR: 0.15), and American Indian/Alaska Native (AAMR: 0.11) populations. Southern (AAPC: 1.3%) and non-metropolitan US regions (AAPC: + 1.9%) had the highest increase in annual mortality change. Our findings highlight the disparities in ICH mortality in patients with AF. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities.

Pharmaceutical management of hemorrhagic stroke: Optimizing outcomes following intracranial hemorrhage evacuation

Stroke can be mainly categorized into hemorrhagic and ischemic stroke. Intracerebral hemorrhage (ICH) is a subtype of hemorrhagic stroke that is caused due to unconstrained bleeding within the parenchyma of the brain. ICH is one of the major conditions that have a high rate of disease and a high rate of death in a given population. Risk factors for ICH emerged to be age, male gender, hypertension, and intake of alcohol in huge quantities. The frequency of ICH is increased where hypertension is mainly untreated. To improve the prognosis and outcomes of an ICH patient, we need to perform emergent evacuation of blood from the brain parenchyma and prevent edema formation while restricting further neuronal damage due to surgical intervention. Evidence-based guidelines exist for ICH and form the basis for a care framework. The pharmaceutical management of ICH from current literature includes an aggressive reduction in blood pressure, tranexamic acid use, and recombinant activated factor VII administration. In addition, advanced imaging, surgical evacuation of ICH, and minimally invasive surgery techniques for hematoma evacuation could provide great benefits to patients with a large ICH.

Identification of key genes in spontaneous cerebral hemorrhage and prevention of disease damage: LASSO and SVM regression

Prevention is more important than treatment, and the incidence of intracerebral hemorrhage can be effectively reduced by intervening on the risk factors of intracerebral hemorrhage. By studying the risk factors of spontaneous intracerebral hemorrhage, we can identify the risk factors to achieve the target of treatment and prevention. Through the use of the Least Absolute Shrinkage and Selection Operator (LASSO) and the Support Vector Machine (SVM), the two essential SICH-related genes, NUAK1 and ERO1L, were eliminated from consideration. A Venn analysis was performed, and based on the two important modules, it found that SICH was related with four critical genes: VCM1, CRNDE, COL6A2, and HSPB6. One gene (NUAK1) was dramatically downregulated in the illness group compared to the control group, whereas three essential genes (ERO1L, VCAM1, and COL6A2) were significantly upregulated in the disease group. In the end, the genes ERO1L, VCAM1, COL6A2, and NUAK1 were shown to be the most important ones for SICH. It is anticipated that these genes will become novel biomarkers as well as targets for the development of new pharmacotherapies for SICH.

Association between intracerebral hemorrhage and cholesterol levels, and molecular mechanism underlying low cholesterol inhibiting autophagy in cerebral arterial smooth muscle cells leading to cell necrosis

BackgroundAn association between cholesterol and intracerebral hemorrhage (ICH) has been reported, but the mechanism is unclear. MethodsIn this cross-sectional study, participants aged 50–75 years were selected using multistage stratified cluster sampling. All samples completed a questionnaire (age, gender, medication, etc.) and were examined (blood lipid, height, blood pressure, etc.) for risk factors. Multivariable logistic regression was used to analyze the association between cholesterol levels and ICH risk, after adjusting for age, smoking, hypertension, and other factors. We cultured rat cerebral artery smooth muscle cells at different cholesterol concentrations. The autophagy pathway was identified by transcriptome sequencing. The results were then validated using real-time polymerase chain reaction and western blot. ResultsWe included 39,595 patients, among whom 286 had ICH. The study showed that a low level of low-density lipoprotein cholesterol (LDL-C) was a risk factor of ICH (odds ratio 2.912, 95% confidence interval 1.460–5.806; P = 0.002). Cell experiments showed that lower cholesterol levels could significantly induce rat cerebral artery smooth muscle cell necrosis. In low-cholesterol groups, expression of the autophagy marker LC3 protein was significantly decreased and p62 protein was significantly increased. In western blot and comparison with the control group, the low cholesterol PI3K/Akt/mTOR signaling pathway was significantly activated in the autophagy pathway, resulting in its inhibition, which in turn led to smooth muscle cell death. ConclusionLow cholesterol levels may inhibit autophagy through PI3K/Akt/mTOR signaling and induce arterial smooth muscle cell necrosis, thereby increasing the risk of ICH.

Effects of air pollution control policies on intracerebral hemorrhage mortality among residents in Tianjin, China

BackgroundExposure to air pollution is an important risk factor for intracerebral hemorrhage (ICH), which is a major cause of death worldwide. However, the relationship between ICH mortality and air quality improvement has been poorly studied. This study aims to evaluate the impact of the air pollution control policies in the Beijing-Tianjin-Hebei region on ICH mortality among Tianjin residents.MethodsThis study used an interrupted time series analysis. We fitted autoregressive integrated moving average (ARIMA) models to assess the changes in ICH deaths before and after the interventions of air pollution control policies based on the data of ICH deaths in Tianjin collected by the Tianjin Center for Disease Control and Prevention.ResultsBetween 2009 and 2020, there were 63,944 ICH deaths in Tianjin, and there was an overall decreasing trend in ICH mortality. The intervention conducted in June 2014 resulted in a statistically significant (p = 0.03) long-term trend change, reducing the number of deaths from ICH by 0.69 (95% confidence interval [CI]: -1.30 to -0.07) per month. The intervention in October 2017 resulted in a statistically significant (p = 0.04) immediate decrease of 25.74 (95% CI: -50.62 to -0.85) deaths from ICH in that month. The intervention in December 2017 caused a statistically significant (p = 0.04) immediate reduction of 26.58 (95% CI: -52.02 to -1.14) deaths from ICH in that month. The intervention in March 2018 resulted in a statistically significant (p = 0.02) immediate decrease of 30.40 (95% CI: -56.41 to -4.40) deaths from ICH in that month. No significant differences were observed in the changes of male ICH mortality after any of the four interventions. However, female ICH deaths showed statistically significant long-term trend change after the intervention in June 2014 and immediate changes after the interventions in December 2017 and March 2018. Overall, the interventions prevented an estimated 5984.76 deaths due to ICH.ConclusionDuring the study period, some interventions of air pollution control policies were significantly associated with the reductions in the number of deaths from ICH among residents in Tianjin. ICH survivors and females were more sensitive to the protective effects of the interventions. Interventions for air pollution control can achieve public health gains in cities with high levels of air pollution.

Dental Caries a Risk Factor for Intracerebral Hemorrhage

Introduction: Streptococcus mutans is a known cause of dental caries that contains a collagen-binding protein, Cnm, and exhibits inhibition of platelet aggregation and matrix metalloproteinase-9 activation. This strain has been linked to aggravation of experimental intracerebral hemorrhage (ICH) and may be a risk factor for ICH. The purpose of this study was to test the association between dental caries and incident ICH. Methods: The presence of dental caries and periodontal disease was assessed in subjects from the Dental Atherosclerosis Risk in Communities (DARIC) study without prior stroke or ICH. This cohort was followed for incident ICH over a period of 10 years. Cox regression was used to compute crude and adjusted hazards ratio from the dental assessment. Results: Among 6,315 subjects, dental surface caries and/or root caries were recorded in 1,338 (27%) subjects. Of those, 7 (0.5%) had incident ICH over a period of 10 years following the visit 4 assessment. Of the remaining 4,977 subjects, 10 (0.2%) had incident ICH. Those with dental caries versus those without dental caries were slightly younger (mean age 62.0 ± 5.7 vs. 62.4 ± 5.6, p = 0.012), had a greater proportion of males (51 vs. 44%, p < 0.001), African Americans (44 vs. 10%, p < 0.001), and were hypertensive (42 vs. 31%, p < 0.001). The association between caries and ICH was significant (crude HR 2.69, 95% CI 1.02–7.06) and strengthened after adjustment for age, gender, race, education level, hypertension, and periodontal disease (adjusted HR 3.88, 95% CI 1.34–11.24). Conclusion: Dental caries is a potential risk for incident ICH after caries detection. Future studies are needed to determine if treatment of dental caries can reduce the risk of ICH.

Risk factors of intracerebral hemorrhage among the young population in Qatar: Are genetic risk factors involved?

Background: Intracerebral hemorrhage (ICH) has not been widely investigated in young adults. This study aims to describe the risk factors of ICH with a focus on the possible effect of non-modifiable risk factors, such as genetic factors, to assess the ICH outcomes, and to identify the prognostic factors after ICH among young adult patients. Methods: This prospective and observational study was conducted at two hospitals at Hamad Medical Corporation, Qatar, namely Hamad General Hospital and Alkhor Hospital. The study included young patients (16–45 years old) admitted with ICH between January 1, 2015, and December 31, 2018. Results: We examined 238 consecutive young patients with ICH consisting of 212 (89.1%) males and 26 (10.9%) females. The mean age was 37.8±6.23 years. The most common risk factor found in 187 (78.6%) patients was hypertension (HTN), while 19 (8.0%) patients had no obvious risk factors (cryptogenic). The primary site of bleeding was cerebral cortex (lobar) in 107 (44.96%) patients and then basal ganglia in 97 (40.76%) patients. The in-hospital mortality was 19 (8.0%); the National Institutes of Health Stroke Scale &gt;14 on admission (adjusted OR=2.06; 95% CI=1.448–2.938; p&lt;0.001), Barthel index score ≤40 on admission (adjusted OR=1.09; 95% CI=1.015–1.178; p=0.019), and HTN (adjusted OR=0.075; 95% CI=0.008–0.724; p=0.025) were found to be independent predictors of in-hospital mortality by multivariate analysis. A 1-year follow-up showed mortality in 7 (3.2%) patients and no new events in 139 (63.8%) cases. Conclusion: HTN, smoking, and excessive alcohol consumption are important modifiable risk factors for ICH among young patients in Qatar, requiring early identification and treatment to prevent this dangerous type of stroke. In addition, we recommend conducting further studies focusing on the genetic risk factors of ICH among young adults, particularly those with cryptogenic ICH, to identify whether genetic risk factors are involved.

Risk factors for intracerebral hemorrhage in patients undergoing maintenance hemodialysis.

In patients undergoing hemodialysis, intracerebral hemorrhage (ICH) is the main cause of mortality among stroke subtypes. It is unclear whether, along with traditional cardiovascular risk factors, the risk factors unique to the uraemic environment, such as the abnormal metabolism of intact parathyroid hormone (iPTH), can contribute to the risk of ICH in these patients. This retrospective case-control study included 25 patients undergoing hemodialysis with ICH at a single center between 30 June 2015 and 10 October 2022. The controls were 95 patients undergoing maintenance hemodialysis treated at the same dialysis center in July 2020. We compared the characteristics of patients with ICH with those of the control group to identify factors that contributed to the development of ICH. Intracerebral hemorrhage (ICH) was located in the basal ganglia (14/25), cerebellum (6/25), and brainstem (6/25) in 25 patients. A total of 17 patients died in the first 16 days due to neurological complications. Univariate analysis showed significant differences in systolic BP, diastolic BP, iPTH, and alkaline phosphatase between the two groups (p < 0.05). Multivariate logistic regression analysis showed that higher systolic BP (OR, 1.053; 95% CI, 1.018-1.090; p = 0.003) and higher iPTH (OR, 1.007; 95% CI, 1.003-1.012; p = 0.001) were associated with the onset of ICH. ICH was predicted by systolic BP and iPTH by receiver operating characteristic (ROC) curve analysis, with areas under the curve (AUCs) of 0.732 and 0.624, respectively. The optimal cutoffs for systolic BP and iPTH were 151.9 mmHg and 295.4 pg./ml, respectively. Restricted cubic spline showed that the shape of the association of iPTH with the risk of ICH was approximately J-shaped (P for non-linearity <0.05). Higher systolic BP and abnormal iPTH metabolism might be associated with ICH in patients undergoing hemodialysis. Comprehensive control of hypertension and iPTH may be a fundamental preventive strategy for ICH in these patients.

Abstract TMP47: IMPROVING Time To Anti-Coagulation Reversal For Hemorrhagic Strokes

Background: Oral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed as quickly as possible, many health care systems have not developed a process for optimizing that aspect of care. Methods: Through the IMPROVE Stroke Care Consortium, a group of nine Hub hospitals and their regional community hospitals, a systems of care improvement project was implemented. Performance reviews identified best practices which were disseminated throughout all centers. We compared the median door-to-reversal (DTR) time before and after an institutional campaign to speed the process with a target time of 60 minutes. Results: Over two years of the study, there were 6,699 ischemic strokes, 152 subarachnoid hemorrhages, and 889 intracranial hemorrhages. During that time, 36 hemorrhagic stroke patients received reversal agents emergently. The baseline median DTR time was 123 minutes (IQR 99, 361 minutes) for all comers. By the end of the program, the median DTR time had been reduced to 92.5 minutes (IQR 59, 163 minutes) which is a trend towards 59% reduction of DTR from baseline (p=0.08). Conclusions: Utilizing an integrated stroke systems of care approach we were able to reduce DTR times for patients presenting with acute ICH and concurrent use of anticoagulants in spite of the lack of definitive guidelines as to how quickly reversing agents should be given.