The burden of intracerebral haemorrhage remains high Study emphasises the need for more effective treatments in this condition

Intracerebral haemorrhage remains the most severe subtype of stroke with a high burden and devastating consequences. Better prevention and more effective acute treatments are needed. Researchers from the Radboudumc published these conclusions in The Lancet Regional Health - Europe.

Intracerebral haemorrhage – also known as haemorrhagic stroke or brain haemorrhage – results from the sudden rupture of blood vessels in the brain, often causing severe neurological deficits. Despite many efforts, effective treatments are still lacking. Previous research showed that mortality due to intracerebral haemorrhage is high, and of those surviving, only few are able to live independently afterwards. However, recent estimates of these parameters are not available. Over the past decades, the prevalence of risk factors has altered, effort has been put into prevention, and specialised stroke units have been implemented worldwide. These changes may have altered the occurrence and outcome of intracerebral haemorrhage.

Therefore, the research group led by neurologist Karin Klijn from Radboudumc decided to update their earlier work on the worldwide incidence, case fatality, and functional outcome of intracerebral haemorrhage.

Results

In their systematic review and meta-analysis, the study team analysed data from 70 studies across 26 countries, covering a total population of more than 19 million people.

They found that the global incidence of intracerebral haemorrhage was 29.2 cases per 100,000 person-years. The incidence was higher in men than women, increased with age, and was higher in lower income countries compared to higher income countries. Of the patients suffering from intracerebral haemorrhage, 35.5% was deceased within one month and less than one-third (31.2%) functioned independently after one year. Importantly, the researchers found that these outcomes did not improve over the last 15 years, despite all the efforts to optimise acute care for these patients.

Implications

The results of this study demonstrate the urgent need for improved strategies to prevent intracerebral haemorrhage, especially in lower income countries. Furthermore, this study shows that more effective acute treatments in intracerebral haemorrhage are necessary to improve the outcome of these patients.

Currently, the same research group is working towards the development of these new treatment strategies as leading investigators of two randomised clinical trials aimed at reducing brain damage after intracerebral haemorrhage. In the Dutch Intracerebral Haemorrhage Surgery Trial (DIST; NCT05460793; www.dutch-ich.nl; part of CONTRAST), they investigate whether minimally invasive surgical removal of the haemorrhage is beneficial, while the Anakinra in Cerebral Haemorrhage to Target Secondary Injury Resulting from Neuroinflammation (ACTION; NCT04834388; www.action-study.nl) trial aims to limit additional brain injury after intracerebral haemorrhage due to neuroinflammation. Both studies are ongoing. 

The article is linked to research program Cerebrovascular Diseases.

About the publication
This study has been published in The Lancet Regional Health – Europe: Incidence, case fatality, and functional outcome of intracerebral haemorrhage, according to age, sex, and country income level: a systematic review and meta-analysis. Axel Wolsink, Maaike P. Cliteur, Charlotte J. van Asch, Jeroen D. Boogaarts, Ruben Dammers, Gerjon Hannink, Floris H.B.M. Schreuder, Catharina J.M. Klijn