Editors' Note: Cause of Death in Spontaneous Intracerebral Hemorrhage Survivors: Multistate Longitudinal Study

Using administrative claims data from 3 US states, Dr. Kuohn et al. report the long-term mortality rate of survivors with spontaneous intracerebral hemorrhage (ICH). Using an original population of 104,000 patients who were screened for eligibility, 72,432 survivors of the index hospitalization were followed for a median of 4 years. The 1-year risk of death or discharge to hospice was 9.5% (95% CI 9.2%–9.7%), with the most common proximate causes of death being infection (34%) or subsequent intracranial hemorrhage (13%). The median time from ICH to death was 10 months (IQR 2–31 months). Dr. Llamas-Nieves and colleagues highlight the importance of confounders such as diabetes, which was independently associated with death as shown in the multivariable regression model (HR 1.22, 95% CI 1.17–1.27), as this may be an important mediator of death because of infectious causes. The investigators acknowledge that diabetes contributes to death in the overall population; however, it was not independently associated with death due to infection (OR 1.16, 95% CI 0.86–1.55). The authors posit that diabetes (as well as age, post-ICH disability, and other comorbidities) are important contributors to the development of later infection, but it remains unclear why diabetes is not an independent modifier of death risk among patients who develop infection.

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