Loggini Andrea, Saleh Velez Faddi G, Towner James E, Hornik Jonatan, Wallery Md Shawn S, Battaglini Denise, Schwertman Amber, Nomani Sarmad, Hornik Alejandro, Qureshi Adnan I, Del Brutto Victor J
Brain and Spine Institute. Southern Illinois Healthcare, Carbondale, IL, USA; Southern Illinois University School of Medicine, Carbondale, IL, USA.
Brain Stimulation and Neurorehabilitation Laboratory, Department of Neurology. University of Oklahoma Health Sciences Center, Oklahoma City. OK, USA.
J Clin Neurosci. 2025 Jul;137:111300. doi: 10.1016/j.jocn.2025.111300. Epub 2025 May 5.
This study aims to analyze the temporal trends of comorbidities, complications, and in-hospital mortality of non-traumatic intracerebral hemorrhages (ICH) over the past two decades using a nationwide inpatient sample.
The National Inpatient Sample database was screened to identify patients hospitalized with ICH from 2002 to 2022. Socio-demographic characteristics, comorbidities, complications (including ischemic stroke, seizures, aspiration pneumonia, and deep vein thrombosis/pulmonary embolism DVT/PE), neurosurgical procedures, tracheostomy, and percutaneous gastrostomy placement were reviewed. Length of hospital stay and in-hospital mortality were analyzed. Temporal trends were determined using linear logistic regression models for each predetermined variable. For dichotomous variables, the natural logarithm was calculated to achieve a harmonic linear trend. Pairwise comparison was used for subgroup analyses.
A total of 467,117 patients with ICH were included in the study. From 2002 to 2022, there was a significant increase in comorbidities, including hypertension, diabetes, chronic kidney disease, obesity, and anticoagulant use, p < 0.01 for all. Patients' age progressively decreased over time (β:-0.104, 95 %CI: -0.124-0.085, p < 0.01). Notably, a temporal increase in ischemic stroke (β:0.081, 95 %CI: 0.069-0.092, p < 0.01) and seizures (β:0.012, 95 %CI: 0.001-0.008, p < 0.01) was noted. Clot removal/decompression declined over the years (β:-0.039, 95 %CI: -0.057-0.022, p < 0.01) while EVD/VPS placement increased (β:, 95 %CI: -0.057-0.022, p < 0.01). Length of hospital stay increased yearly by 0.07 days (95 %CI: 0.04-0.08, p < 0.01). The average annual mortality rate significantly decreased by 2.43 % per year (95 %CI: -2.21 %-2.65 %, p < 0.01). In-hospital mortality rates declined more rapidly in urban areas compared to rural areas (0.99 % difference, 95 %CI: 0.5 %-1.48 %, p < 0.01). No statistical difference was observed among sex, racial or income groups; however, there was a trend toward a slower decline in in-hospital mortality among lower-income compared to higher-income groups.
Despite increasing patient complexity, in-hospital mortality has steadily decreased in ICH patients over the last two decades. These improvements have come at the cost of longer hospital stays. Profound inequities remain in the mortality rate in rural areas.
本研究旨在利用全国住院患者样本分析过去二十年非创伤性脑出血（ICH）的合并症、并发症及住院死亡率的时间趋势。
对全国住院患者样本数据库进行筛选，以确定2002年至2022年期间因ICH住院的患者。回顾了社会人口统计学特征、合并症、并发症（包括缺血性卒中、癫痫发作、吸入性肺炎和深静脉血栓形成/肺栓塞DVT/PE）、神经外科手术、气管切开术和经皮胃造瘘术的放置情况。分析了住院时间和住院死亡率。使用线性逻辑回归模型对每个预定变量确定时间趋势。对于二分变量，计算自然对数以实现谐波线性趋势。采用两两比较进行亚组分析。
本研究共纳入467117例ICH患者。从2002年到2022年，合并症显著增加，包括高血压、糖尿病、慢性肾脏病、肥胖症和抗凝剂使用，所有这些的p<0.01。患者年龄随时间逐渐下降（β：-0.104，95%CI：-0.124至-0.085，p<0.01）。值得注意的是，缺血性卒中（β：0.081，95%CI：0.069至0.092，p<0.01）和癫痫发作（β：0.012，95%CI：0.001至0.008，p<0.01）出现时间增加趋势。多年来，血块清除/减压术减少（β：-0.039，95%CI：-0.057至-0.022，p<0.01），而脑室外引流/脑室腹腔分流术放置增加（β：，95%CI：-0.057至-0.022，p<0.01）。住院时间每年增加0.07天（95%CI：0.04至0.08，p<0.01）。平均年死亡率每年显著下降2.43%（95%CI：-2.21%至-2.65%，p<0.01）。与农村地区相比，城市地区的住院死亡率下降得更快（差异0.99%，95%CI：0.5%至1.48%，p<0.01）。在性别、种族或收入组之间未观察到统计学差异；然而，与高收入组相比，低收入组的住院死亡率下降趋势较慢。
尽管患者复杂性增加，但在过去二十年中，ICH患者的住院死亡率稳步下降。这些改善是以更长的住院时间为代价的。农村地区的死亡率仍存在严重不平等。
