Race-Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites.

BACKGROUND: Intracerebral hemorrhage (ICH) carries high risk for short-term mortality. We sought to identify race-specific predictors of mortality in ICH patients.

METHODS AND RESULTS: We used 2 databases, the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample (NIS). We included 226 patients with the primary diagnosis of spontaneous ICH from our stroke database between 2010 and 2013; in the NIS, 42 077 patients met inclusion criteria. Logistic regression was used to assess differences in predictors of mortality in blacks compared to whites. In our clinical stroke database, Glasgow Coma Scale (GCS; P=0.016), ICH volume (P=0.013), intraventricular haemorrhage (IVH; P=0.023), and diabetes mellitus (P=0.037) were predictors of mortality in blacks, whereas GCS (P=0.007), ICH volume (P=0.005), age (P=0.002), chronic kidney disease (P=0.003), and smoking (P=0.010) predicted mortality in whites. Among patients with IVH, blacks had over 7 times higher odds of mortality compared to whites (odds ratio [OR], 7.27; P value for interaction, 0.017) and were more likely to present with hydrocephalus (OR, 2.76; P=0.026). In the NIS, black ICH patients had higher rates of external ventricular drain (EVD) placement compared to whites (9.7% vs 5.0%; P<0.001) and were more likely to develop hydrocephalus (OR, 1.32; 95% CI, 1.20-1.46). Comparison of a race-specific ICH score to the original ICH score showed that the various ICH score components have differential relevance for ICH score performance by race.

CONCLUSIONS: IVH and age differentially predict mortality among blacks and whites. Blacks have higher rates of obstructive hydrocephalus and more frequently require EVD placement compared to their white counterparts.