Reader Response: Cause of Death in Spontaneous Intracerebral Hemorrhage Survivors: Multistate Longitudinal Study

We read with great interest the recent article by Kuohn et al.1 The authors conducted a comprehensive review on the factors associated with mortality in patients who survived spontaneous intracerebral hemorrhage, where they showed that the infection was the main cause of death in such a group with a value of 34%. However, they do not emphasize other comorbidities that could have influenced the morbidity and mortality of patients in the infection group, such as diabetes. Diabetes is a disease that increases susceptibility to infections such as those involving the skin, urinary tract, or lungs.2 Lau et al. performed a systematic review and meta-analysis, where they found that isolated diabetes is strongly associated with poor prognosis after stroke, including increased morbidity, mortality, and disability.3 For this reason, it is very important to know the factors that underlie and really impact on the subject of study, to obtain certainty in the results of the research, and to avoid underestimations as what likely happened in the study of Kuohn et al. We suggest separate future study groups to avoid this type of bias during data analysis.

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