Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

BMC Geriatrics

Eulàlia Muria-Subirats¹  Juan Ballesta-Ors²  Blanca Lorman-Carbó³  Maria Antònia González-Henares⁴  Josep Lluís Clua-Espuny⁵  Francisco M. Martín-Luján⁶  José Fernández-Sáez⁷ 

[1] Department of Primary Care, Catalonian Health Institute, EAP Amposta, Amposta, Spain;Department of Primary Care, Catalonian Health Institute, EAP Tortosa-est, UUDD Terres de l’Ebre, Tortosa, Spain;Department of Primary Care, Catalonian Health Institute, EAP Tortosa-est, UUDD Terres de l’Ebre; University Rovira Virgili, Tortosa, Spain;Department of Primary Care, Catalonian Health Institute, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), EAP Alcanar-Sant Carles de la Ràpita, Spain;Department of Primary Care, Catalonian Health Institute, University Rovira i Virgili, CAP El Temple, Plaça Carrilet s/n. 43500, Tortosa, Catalunya, Spain;Department of Primary Care, Catalonian Health Institute; Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol); University Rovira i Virgili, Reus, Spain;Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain;

关键词: Cardiovascular;    Intracerebral haemorrhage;    Complex chronic patient;    HAS-BLED score;   

DOI  :  10.1186/s12877-021-02004-4

来源: Springer

【 摘 要 】

BackgroundDemographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP).MethodsThis is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex.Results161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127–174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88–6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11–2.35], and cardiovascular disease [OR 1.48 IC95% 1.05–2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89–0.97] and negative predictive value [0.98 (CI95% 0.83–1.12)].ConclusionsIn the CCP subgroup the incidence density of ICH was 5–60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH.Trial registrationThis study was retrospectively registered in ClinicalTrials.gov (NCT03247049) on August 11/2017.

【 授权许可】

CC BY