Determinants of Poor Outcome after Intracerebral Hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

Introduction: Intracerebral hemorrhage (ICH) is the most severe subtype of stroke. Its mortality rate is high, and the majority of survivors suffer significant disability. The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study prospectively recruited 1000 non-Hispanic white, 1000 non-Hispanic black, and 1000 Hispanic spontaneous ICH cases to study the epidemiology and genomics of ICH. Herein, we report the primary determinants of 3-month outcome after ICH in a large, multi-ethnic cohort. Methods: Between 2010 and 2015, cases were prospectively recruited with uniform data collection and phenotype definitions, centralized neuroimaging review, and telephone follow-up at 3 months. Individual characteristics were screened for association with 3-month outcome of modified Rankin Scale (mRS) ≥4 versus ≤3 under a logistic regression model, and those meeting P<0.2 were candidates for a multivariate model, in which the final model minimized the Akaike information criterion. Analyses were repeated removing individuals that had withdrawal of care. ICH Score elements were specifically analyzed. Results: Of the 3000 cases, 2568 had a 3-month outcome determination available (including death). Of the 76 characteristics examined univariately, 51 met the P<0.2 criteria, and 25 were retained in the final model. This logistic model had a significantly higher (P=6.2x1022) area under the receiver operating characteristics curve (C = 0.88) compared with ICH score alone (C=0.76). Among the characteristics with the strongest association with poor outcome were log increased ICH volume (OR=2.7), age (OR=1.03) and pre-ICH mRS (OR=1.6), lobar location (OR=0.21), and presence of infection (OR=1.9). Conclusion: ICH score elements were validated as important determinants of 3-month outcome. However, additional patient characteristics that significantly increase our model's predictive ability were also identified and should be considered in future studies. Funding: The study was supported by the National Institute of Neurological Diseases and Stroke (NINDS U01NS069763). Declaration of Interest: CEH received subcontract support under NINDS U01NS069763 from The University of Cincinnati during the life of the Study, and subcontract support under NINDS 1R34NF056638-01 Clear III from Johns Hopkins and subcontract support under NINDS 2P50NS044203-06 STOP-IT from The University of Cincinnati during portions of the life of the trial. CDA receives sponsored research support from the National Institutes of Health of the United States (R01NS103924), the American Heart Association Atrial Fibrillation Strategically Focused Research Network, Massachusetts General Hospital, and Bayer AG, and has consulted for ApoPharma, Inc. No other related conflicts to report. Ethical Approval: IRB approval was obtained at all participating centers, and informed consent was obtained from all cases or their legally authorized representative.