Risk Factors for Lobar and Non-Lobar Intracerebral Hemorrhage in Patients with Vascular Disease

Philip H C Kremer; Wilmar M T Jolink; L Jaap Kappelle; Ale Algra; Catharina J M Klijn; SMART and ESPRIT Study Groups

doi:10.1371/journal.pone.0142338

Risk Factors for Lobar and Non-Lobar Intracerebral Hemorrhage in Patients with Vascular Disease

PLoS One. 2015 Nov 5;10(11):e0142338. doi: 10.1371/journal.pone.0142338. eCollection 2015.

Authors

Philip H C Kremer¹, Wilmar M T Jolink¹, L Jaap Kappelle¹, Ale Algra^{1

2}, Catharina J M Klijn^{1

3}; SMART and ESPRIT Study Groups

Affiliations

¹ Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
² Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
³ Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.

Abstract

Introduction: Lobar and non-lobar non-traumatic intracerebral hemorrhage (ICH) are presumably caused by different types of small vessel diseases. The aim of this study was to assess risk factors for ICH according to location.

Methods: In two large prospective studies, SMART (n = 9088) and ESPRIT (n = 2625), including patients with manifest cardiovascular, cerebrovascular or peripheral artery disease or with vascular risk factors, we investigated potential risk factors for ICH during follow-up according to lobar or non-lobar location by Cox proportional hazards analyses.

Results: During 65,156 patient years of follow up 19 patients had lobar ICH (incidence rate 29, 95% CI 19-42 per 100,000 person-years) and 24 non-lobar ICH (incidence rate 37, 95% CI 26-51 per 100,000 person-years). Age significantly increased the risk of lobar ICH (HR per 10 years increase 1.90; 95% CI 1.17-3.10) in the multivariable analysis, but not of non-lobar hemorrhage. Anticoagulant medication (HR 3.49; 95% CI 1.20-10.2) and male sex (HR 3.79; 95% CI 1.13-12.8) increased the risk of non-lobar but not lobar ICH.

Conclusion: This study shows an elevated risk of future ICH in patients with manifestations of, or risk factors for, cardiovascular, cerebrovascular or peripheral artery disease. Our data suggest that risk factors for ICH vary according to location, supporting the hypothesis of a differential pathophysiology of lobar and non-lobar ICH.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anticoagulants / therapeutic use
Cerebral Hemorrhage / etiology*
Female
Humans
Male
Middle Aged
Prospective Studies
Risk Factors
Vascular Diseases / complications*

Substances

Anticoagulants

Grants and funding

The study was supported by a grant from the Dutch Brain Foundation (grant number BG 2013-02) to Prof. dr. L.J. Kappelle. Prof dr. C.J.M. Klijn is supported by a clinical established investigator grant of the Dutch Heart Foundation (grant number 2012 T077) and an ASPASIA grant from ZonMw (grant number 015008048). Dr. Jolink was supported by a grant from the Dutch Heart Foundation (Grant Number 2007B48).