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Recurrent intracerebral hemorrhage in patients with cerebral amyloid angiopathy: a propensity-matched case–control study

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Abstract

Objective

Cerebral amyloid angiopathy (CAA) can present with intracerebral hemorrhage (ICH), convexity subarachnoid hemorrhage (SAH), and rarely acute ischemic stroke (AIS). The objective of our study was to compare the readmission rates for recurrent ICH, SAH, and AIS among patients admitted for ICH with and without CAA.

Methods

Using the National Readmissions Database 2016–2018 we identified patients admitted for ICH with and without a concomitant diagnosis of CAA. Primary outcome of the study was readmission due to ICH. Secondary outcomes included readmissions due to AIS and SAH. Survival analysis was performed, and Kaplan–Meier curves were created to assess for readmissions.

Results

The study consisted of 194,290 patients with ICH, 8247 with CAA and 186,043 without CAA as a concomitant diagnosis. After propensity matching, we identified 7857 hospitalizations with CAA and 7874 without CAA. Patients with CAA had higher risk of readmission due to ICH as compared to those without CAA [hazards ratio (HR) 3.44, 95% confidence interval (CI) 2.55–4.64, P < 0.001] during the mean follow-up period of 181.4 (SD ± 106.4) days. Patients with CAA were also more likely to be readmitted due to SAH (HR 2.52, 95% CI 1.18–5.37, P 0.017) but not due to AIS (HR 0.74, 95% CI 0.54–1.01, P 0.061). Age (HR 0.96 per year increase in age, 95% CI 0.94–0.98, P < 0.001) and Medicare payer (HR 3.31; 95% CI 1.89–5.78, P < 0.001) were independently associated with readmissions due to ICH.

Discussion

Patients admitted for ICH with a concomitant diagnosis of CAA are three times more likely to have readmissions for recurrent ICH compared to patients without CAA.

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Data availability

All data for the study are reported in the manuscript. The NRD is a publicly available data set that can be obtained after completion of the HCUP data use agreement.

Code availability

Not applicable.

References

  1. Rodrigues MA, Samarasekera N, Lerpiniere C et al (2018) The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol 17(3):232–240

    Article  Google Scholar 

  2. Greenberg SM, Charidimou A (2018) Diagnosis of cerebral amyloid angiopathy: evolution of the Boston criteria. Stroke 49(2):491–497

    Article  Google Scholar 

  3. Knudsen KA, Rosand J, Karluk D, Greenberg SM (2001) Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology 56(4):537–539

    Article  CAS  Google Scholar 

  4. Fotiadis P, van Rooden S, van der Grond J et al (2016) Cortical atrophy in patients with cerebral amyloid angiopathy: a case-control study. Lancet Neurol 15(8):811–819

    Article  Google Scholar 

  5. Charidimou A, Boulouis G, Haley K et al (2016) White matter hyperintensity patterns in cerebral amyloid angiopathy and hypertensive arteriopathy. Neurology 86(6):505–511

    Article  CAS  Google Scholar 

  6. Reijmer YD, van Veluw SJ, Greenberg SM (2016) Ischemic brain injury in cerebral amyloid angiopathy. J Cereb Blood Flow Metab 36(1):40–54

    Article  CAS  Google Scholar 

  7. Raposo N, Charidimou A, Roongpiboonsopit D et al (2020) Convexity subarachnoid hemorrhage in lobar intracerebral hemorrhage: a prognostic marker. Neurology 94(9):e968–e977

    Article  Google Scholar 

  8. Pinho J, Araujo JM, Costa AS et al (2021) Intracerebral hemorrhage recurrence in patients with and without cerebral amyloid angiopathy. Cerebrovasc Dis Extra 11(1):15–21

    Article  Google Scholar 

  9. Charidimou A, Imaizumi T, Moulin S et al (2017) Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: a meta-analysis. Neurology 89(8):820–829

    Article  Google Scholar 

  10. Overview of the Nationwide Readmissions Database (NRD). https://www.hcup-us.ahrq.gov/nrdoverview.jsp. Accessed 30 Apr 2021

  11. National inpatient sample: APR-DRGs methodology overview 31. https://www.hcup-us.ahrq.gov/db/nation/nis/grp031_aprdrg_meth_ovrview.pdf. Accessed 5 Jan 2020

  12. Xian Y, Holloway RG, Pan W, Peterson ED (2012) Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates. Stroke 43(6):1687–1690

    Article  Google Scholar 

  13. Moradiya Y, Murthy SB, Newman-Toker DE, Hanley DF, Ziai WC (2014) Intraventricular thrombolysis in intracerebral hemorrhage requiring ventriculostomy: a decade-long real-world experience. Stroke 45(9):2629–2635

    Article  Google Scholar 

  14. Heeringa SG, West BT, Berglund PA (2010) Applied survey data analysis. Chapman and Hall/CRC, Boca Raton

    Book  Google Scholar 

  15. Biessels GJ (2020) Cerebral amyloid angiopathy: still a syndromal diagnosis. Stroke 51(12):3487–3488

    Article  Google Scholar 

  16. Charidimou A, Boulouis G, Greenberg SM, Viswanathan A (2019) Cortical superficial siderosis and bleeding risk in cerebral amyloid angiopathy: a meta-analysis. Neurology 93(24):e2192–e2202

    Article  Google Scholar 

  17. McCormick N, Bhole V, Lacaille D, Avina-Zubieta JA (2015) Validity of diagnostic codes for acute stroke in administrative databases: a systematic review. PLoS ONE 10(8):e0135834

    Article  Google Scholar 

  18. Nagaraja N, Patel UK (2021) Disparities in diagnosis of cerebral amyloid angiopathy based on hospital characteristics. J Clin Neurosci 89:39–42

    Article  Google Scholar 

  19. Charidimou A, Frosch MP, Al-Shahi Salman R et al (2019) Advancing diagnostic criteria for sporadic cerebral amyloid angiopathy: study protocol for a multicenter MRI-pathology validation of Boston criteria v2.0. Int J Stroke 14(9):956–971

    Article  Google Scholar 

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Acknowledgements

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Aayushi Garg, Santiago Ortega‑Gutierrez & Mudassir Farooqui

  2. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Santiago Ortega‑Gutierrez

  3. Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Santiago Ortega‑Gutierrez

  4. Department of Neurology, Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive Suite 2800, PO Box 859, Hershey, PA, 17033, USA

    Nandakumar Nagaraja

Authors
  1. Aayushi Garg
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  2. Santiago Ortega‑Gutierrez
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  3. Mudassir Farooqui
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  4. Nandakumar Nagaraja
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Contributions

AG: study design, statistical analysis, data interpretation, drafting and revision of the manuscript for intellectual content. SO‑G: study design, data interpretation, revision of the manuscript for intellectual content. MF: data interpretation, revision of the manuscript for intellectual content. NN: design and study conception, data interpretation, drafting and revision of the manuscript for intellectual content.

Corresponding author

Correspondence to Nandakumar Nagaraja.

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Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study was exempt from the Institutional Review Board review as we used a publicly available database with deidentified information.

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Not applicable.

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Not applicable.

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Garg, A., Ortega‑Gutierrez, S., Farooqui, M. et al. Recurrent intracerebral hemorrhage in patients with cerebral amyloid angiopathy: a propensity-matched case–control study. J Neurol 269, 2200–2205 (2022). https://doi.org/10.1007/s00415-021-10937-4

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  • DOI: https://doi.org/10.1007/s00415-021-10937-4

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