Identifier: TDX:4070
Authors: Lorman Carbó, Blanca
Abstract:
Introduction: Intracerebral hemorrhage (ICH) is considered the least prevalent type of cerebrovascular disease, but the most lethal. However, its incidence increases in patients with chronic pathologies with more complexity and multimorbidity. Objectives: a) To study the epidemiology and risk factors of ICH in complex chronic patients (CCPs) and the fourth adjusted morbidity group (GMA-4), b) To evaluate the usefulness of the HAS-BLED scale to identify those with higher risk of ICH. Methodology: Multicentre, retrospective, community-based cohort study in Terres de l’Ebre, designed in two phases. In the first, CCPs are studied, and in the second, subjects of the GMA-4, with no previous history of ICH. 5-year follow-up, during the period 01/01/2013-31/12/2017, and 01/01/2015-31/12/2019, respectively. Main variable: ICH episode; sociodemographic, clinical, and pharmacological covariates are collected. Descriptive statistical and logistic regression analyzes. Main results: ICH incidence density of 151 / 10,000 person-years (95% CI 127-174) for CCPs, and 85/10,000 person-years (95% CI 85-86) for GMA-4 subjects. Main risk factors for ICH: HAS-BLED score ≥3 (OR 3.54; 95% CI 1.88-6.68), hypercholesterolemia (OR 1.62; 95% CI 1.11-2.35) and cardiovascular disease (OR 1.48; 95% CI 1.05-2.09) for CCPs; age≥80 years-old (HR 1.77; 95% CI 1.15-2.20), high complexity (HR 1.59; 95% CI 1.15-2.20) and antiplatelet treatment (HR 1.48; 95% CI 1.07-2.05) for GMA–4 subjects. A HAS-BLED score ≥3 had a sensitivity of 93% to predict ICH, with a negative predictive value of 98% and an AUC (area under the ROC curve) of 0.7.
Conclusions: In CCPs and GMA-4 subjects, the incidence density of ICH is much higher than that observed in the general population. The use of the HAS-BLED scale could improve the preventive approach for those at higher risk, which increases with age, complexity, and the use of antiplatelet agents.
Repositori URV