Functional outcome after ischaemic stroke and intracerebral haemorrhage from two national cohorts
Year: 2026
Type: article
Abstract: Background Outcome of acute ischaemic stroke (AIS) improved considerably through intravenous thrombolysis (IVT) and endovascular therapy (EVT), while treatment options for intracerebral haemorrhage (ICH) remained limited. We compared functional outcome 3 months after AIS and ICH in contemporary patients from two national stroke registries. Methods This is a pooled analysis of the prospective Swiss and Norwegian Stroke Registries. We enrolled all patients with AIS and ICH between 2014 and 2022/2023. The primary outcome was favourable functional outcome (modified Rankin Scale 0–2) at 3 months. Results We included 111 038 patients: 98 354 patients with AIS (21 946/22.4% patients received IVT and 8270/8.4% patients received EVT) and 12 684 patients with ICH. Baseline National Institutes of Health Stroke Scale (NIHSS) was higher in patients with ICH (AIS: median 3, IQR 1–7 vs ICH median 7, IQR 2–15). Overall, 64 135 patients with AIS (65.2%) and 4620 patients with ICH (36.4%) had a favourable functional outcome. ICH was independently associated with poor outcome (adjusted OR (aOR) for favourable functional outcome: 0.42, 95% CI 0.39 to 0.45, p<0.001). Sensitivity analysis excluding patients receiving IVT/EVT confirmed the finding with attenuated magnitude (aOR 0.61, 95% CI 0.56 to 0.66, p<0.001). GSEM analysis found a significant negative direct (β-coefficient −0.77) and indirect effect of ICH on outcome. The indirect effect was mediated through higher baseline NIHSS (β-coefficient=+4.55) and availability of IVT/EVT for AIS (β-coefficient=−21.74 and −22.11, respectively). Overall, the effect of ICH on outcome was split between direct (47%) and indirect (53%) effects. Conclusion Functional outcome after ICH is worse compared with AIS. Measured clinical mediators only partly explain the differences and unmeasured overall care directions (ie, care limitations) may have contributed.
Authors: Janis Rauch, Trine Lied-Herland, Bernhard M Siepen, Martina B Goeldlin, Silje Holt Jahr, Elias Auer, Soffien Ajmi, Greta Soekeland, Anette Farmen, Yasaman Safarkhanlo, Agnethe Eltoft, Marta Garés Caballer, Fredrik Ildstad, Michail Giannakakis, Maria Carlsson, Alexandros A Polymeris, Annette Fromm, Stefan Engelter, Timo Kahles, Davide Strambo, Emmanuel Carrera, Isabel C Hostettler, Susanne Wegener, Nils Peters, Carlo Cereda, Susanne Renaud, Julien Niederhauser, Manuel Bolognese, Christophe Bonvin, Marie-Luise Mono, Friedrich Medlin, Pamela Correia, Alexander A Tarnutzer, Werner Josef Z’Graggen, Adnan Mujanovic, Johannes Kaesmacher, Marcel Arnold, Melinda B Roaldsen, Thomas Meinel, Arnstein Tveiten, Urs Fischer, Ole Morten Rønning, Bastian Volbers, Else Charlotte Sandset, Mira Katan, Espen Saxhaug Kristoffersen, David J Seiffge
Institutions: University of Bern, University Hospital of Bern, University of Oslo, Akershus University Hospital, University of Oxford, Stavanger University Hospital, Innlandet Hospital Trust, University Hospital of North Norway, UiT The Arctic University of Norway, Norwegian University of Science and Technology, St Olav's University Hospital, Nordland Hospital Trust, University Hospital of Basel, Haukeland University Hospital, University of Basel, Felix Platter-Hospital, Kantonsspital Aarau, University of Lausanne, University Hospital of Geneva, University of St.Gallen, Technical University of Munich, University of Zurich, University Hospital Zurich, Klinik Hirslanden, Ospedale regionale di Lugano, Hospital Neuchâtel, Hôpital de Sion, Luzerner Kantonsspital, Hôpital du Valais, Stadtspital Waid, Fribourg Development Agency, Kantonsspital Baden, Hospital of Southern Norway, Oslo University Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7221635979