Maria Antonia González-Henares1,2, Jose Luis Clua-Espuny3,4, Blanca Lorman-Carbo5, Jose Fernández-Saez6, Lluisa Queralt-Tomas7, Eulalia Muria-Subirats5, Juan Ballesta-Ors5, Jose Vicente Gil-Guillen8,9. 1. EAP-Alcanar-St Carlos de la Rápita, Catalonian Health Institute, SAP Terres de l'Ebre, Health Department, Generalitat de Catalunya, CAP St Carles de la Rápita, 43540, Sant Carles de la Ràpita, Spain. 2. Department of Research, ICS Terres de l'Ebre, Research Institute University Primary Care (IDIAP) Jordi Gol, Barcelona, Spain. 3. Department of Research, ICS Terres de l'Ebre, Research Institute University Primary Care (IDIAP) Jordi Gol, Barcelona, Spain. jlclua@telefonica.net. 4. EAP-Tortosa 1-Est Catalonian Health Institute, SAP Terres de l'Ebre, Health Department, Generalitat de Catalunya, CAP Temple, Plaça Carrilet, s/núm, 43500, Tortosa, Spain. jlclua@telefonica.net. 5. UUDD Tortosa-Terres de l'Ebre, Catalonian Health Institute, SAP Terres de l'Ebre, Health Department, Generalitat de Catalunya, CAP Temple, 43500, Tortosa, Spain. 6. Unitat de Suport a la Recerca Terres de l'Ebre, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Grupo de investigación de Salud Pública, Universidad de Alicante, Alicante, Spain. 7. EAP-Tortosa-Oest, Catalonian Health Institute, SAP Terres de l'Ebre, Health Department, Generalitat de Catalunya, CAP Xerta, 43592, Xerta, Spain. 8. Universidad Miguel Hernández, Cátedra Medicina de Familia, Carretera Alicante-Elche s/num, 03202, Elche, Spain. 9. Clinical Evidence Based Medicine and Emotional Department, Miguel Hernández University, Family and Community Specialty, Elche, Spain.
Abstract
INTRODUCTION: Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings. METHODS: This was a multicenter and retrospective study (April 1, 2006-December 31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan-Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January 1, 2013-December 31, 2017) of the population of complex chronic patients with an episode of ICH. RESULTS: A total of 3594 people aged ≥ 65 years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4 years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013-December 31, 2017). The primary outcome was death from any cause within 5 years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80 years (HR 1.048, 95% CI 1.021-1.076, p < 0.001) and HAS-BLED score (HR 1.369, 95% CI 1.057-1.774, p = 0.017). Compared to the general population, the incidence density/1000 person per year (15 vs 0.22) was significantly higher with a significantly lower annual lethality rate (17% vs 49.2%); and both the prognostic factors and the risk of stratified mortality showed different epidemiological patterns. The internal validation of the model was optimal (log-rank < 0.0001) in the general population, but its external validation was not significant in the complex chronic patient population (log-rank p = 0.104). CONCLUSIONS: The ICH-AP is a clinical scale that can improve the prognostic prediction of mortality in primary care after an episode of ICH in the general population, but it was not significant in its external validation in a population of complex chronic patients. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03247049.
INTRODUCTION: Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings. METHODS: This was a multicenter and retrospective study (April 1, 2006-December 31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan-Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January 1, 2013-December 31, 2017) of the population of complex chronic patients with an episode of ICH. RESULTS: A total of 3594 people aged ≥ 65 years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4 years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013-December 31, 2017). The primary outcome was death from any cause within 5 years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80 years (HR 1.048, 95% CI 1.021-1.076, p < 0.001) and HAS-BLED score (HR 1.369, 95% CI 1.057-1.774, p = 0.017). Compared to the general population, the incidence density/1000 person per year (15 vs 0.22) was significantly higher with a significantly lower annual lethality rate (17% vs 49.2%); and both the prognostic factors and the risk of stratified mortality showed different epidemiological patterns. The internal validation of the model was optimal (log-rank < 0.0001) in the general population, but its external validation was not significant in the complex chronic patient population (log-rank p = 0.104). CONCLUSIONS: The ICH-AP is a clinical scale that can improve the prognostic prediction of mortality in primary care after an episode of ICH in the general population, but it was not significant in its external validation in a population of complex chronic patients. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03247049.
Authors: Blanca Lorman-Carbó; Josep Lluis Clua-Espuny; Eulalia Muria-Subirats; Juan Ballesta-Ors; Maria Antònia González-Henares; Meritxell Pallejà-Millán; Francisco M Martín-Luján Journal: Int J Environ Res Public Health Date: 2021-12-17 Impact factor: 3.390