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Haupenthal D, Kuramatsu JB, Volbers B, et al. Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury. JAMA Netw Open. 2021;4(7):e2115859doi: 10.1001/jamanetworkopen.2021.15859.
Haupenthal, D., Kuramatsu, J. B., Volbers, B., Sembill, J. A., Mrochen, A., Balk, S., Hoelter, P., Lücking, H., Engelhorn, T., Dörfler, A., Schwab, S., Huttner, H. B., & Sprügel, M. I. (2021). Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury. JAMA network open, 4(7), e2115859. https://doi.org/10.1001/jamanetworkopen.2021.15859
Haupenthal, David, et al. "Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury." JAMA network open vol. 4,7 (2021): e2115859. doi: https://doi.org/10.1001/jamanetworkopen.2021.15859
Haupenthal D, Kuramatsu JB, Volbers B, Sembill JA, Mrochen A, Balk S, Hoelter P, Lücking H, Engelhorn T, Dörfler A, Schwab S, Huttner HB, Sprügel MI. Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury. JAMA Netw Open. 2021 Jul 01;4(7):e2115859. doi: 10.1001/jamanetworkopen.2021.15859. PMID: 34279649; PMCID: PMC8290300.
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JAMA Netw Open. 2021 Jul 01;4(7):e2115859. doi: 10.1001/jamanetworkopen.2021.15859.

Disability-Adjusted Life-Years Associated With Intracerebral Hemorrhage and Secondary Injury.

JAMA network open

David Haupenthal, Joji B Kuramatsu, Bastian Volbers, Jochen A Sembill, Anne Mrochen, Stefanie Balk, Philip Hoelter, Hannes Lücking, Tobias Engelhorn, Arnd Dörfler, Stefan Schwab, Hagen B Huttner, Maximilian I Sprügel

Affiliations

  1. Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
  2. Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

PMID: 34279649 PMCID: PMC8290300 DOI: 10.1001/jamanetworkopen.2021.15859

Abstract

IMPORTANCE: Intracerebral hemorrhage (ICH) contributes significantly to the global burden of disease.

OBJECTIVE: To examine the association of ICH and secondary injury with disability-adjusted life-years (DALYs) for the individual patient.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted using data from the Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage study. Consecutive patients admitted to a single tertiary care center from January 1, 2006, to December 31, 2015, were included. The sample comprised patients with oral anticoagulation-associated ICH (OAC-ICH) or primary spontaneous ICH (non-OAC-ICH). Statistical analysis was conducted from October 1 to December 31, 2020.

EXPOSURES: ICH occurrence and secondary injury.

MAIN OUTCOMES AND MEASURES: DALYs, years of life lost (YLL), and years lived with disability (YLD) were analyzed by hematoma location, ICH volume, and secondary injury (ie, hematoma expansion [HE], intraventricular hemorrhage [IVH], and perihemorrhagic edema [PHE]).

RESULTS: Among 1322 patients with ICH, 615 (46.5%) were women and the mean (SD) age at hospital admission was 71 (13) years; ICH was associated with a mean (SD) of 9.46 (8.08) DALYs, 5.72 (8.29) YLL, and 3.74 (5.95) YLD. There were statistically significant differences in mean (SD) DALYs by extent of hematoma volume (< 10 mL ICH: 7.05 [6.79] DALYs; 10-30 mL ICH: 9.91 [8.35] DALYs; >30 mL ICH: 12.42 [8.47] DALYs; P < .001) and ICH location (deep location: 10.60 [8.35] DALYs; lobar location: 8.18 [7.63] DALYs; cerebellum: 8.14 [6.80] DALYs; brainstem: 12.63 [9.21] DALYs; P < .001). Regarding population-level disease burden of secondary injuries after ICH, there was a statistically significant difference in mean (SD) by injury type, with 0.94 (3.19) DALYs for HE, 2.45 (4.16) DALYs for IVH, and 1.96 (2.66) DALYs for PHE (P < .001) among the entire ICH cohort. Regarding individual-level exposure to secondary injuries after ICH, there were a mean (SD) 7.14 (6.62) DALYs for HE, 4.58 (4.75) DALYs for IVH, and 3.35 (3.28) DALYs for PHE among patients with ICH affected by secondary injuries.

CONCLUSIONS AND RELEVANCE: These findings suggest that there is a high burden of disability associated with ICH and secondary injuries, and the findings may guide public health strategies. The study findings further suggest that IVH and PHE may be relevant for the overall outcome of patients with ICH, that DALYs may represent a viable outcome parameter for studies to evaluate treatment outcomes in ICH research, and that IVH and PHE may represent potential treatment targets.

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