White matter lesions and poor outcome after intracerebral hemorrhage A nationwide cohort study

Background: The ability to predict poor outcome is important for patient care and treatment decision-making in cases of intracerebral hemorrhage (ICH). Previous studies have included relatively brief follow-up periods and small numbers of patients, and are limited in terms of considerations regarding individual brain vulnerabilities. Methods: The authors prospectively enrolled 1,321 ICH patients nationwide from 33 hospitals. Clinical, laboratory, and imaging variables, including white matter lesions (WMLs), were collected at admission. Immediate outcome after ICH was measured using total Glasgow Coma Scale (GCS) score at admission, early outcome using 30-day mortality, and long-term outcome using relative risk for mortality. The vital status of included patients was ascertained on December 31, 2006, using Korean National Death Certificates (mean follow-up, 32.6 months). Results: Of the 1,321 ICH patients included, 352 (27.8%) presented with a moderate GCS score (8.5-12.4) and 249 (19.7%) with a severe GCS score (<= 8.4). The mortality rate was 9.1% at day 30 post-ICH and 381 patients (29.8%) had died up to the end of December 2006. Extensive WMLs were associated with severe GCS scores at admission (odds ratio [OR] 2.45, 95% confidence interval [Cl] 1.73-3.46), 30-day mortality (OR 2.52, 95% Cl 1.33-4.75), and the relative risk for mortality (RR 2.61, 95% Cl 1.79-3.82) after adjusting for relevant covariates. Conclusions: These findings suggest that white matter lesions, which may reflect the vulnerability of individual brains to pathologic insults, should be considered when assessing immediate, early, and long-term outcomes after intracerebral hemorrhage. Neurology (R) 2010;74:1502-1510