Outcomes after intracerebral hemorrhage from arteriovenous malformations

Santosh B Murthy; Alexander E Merkler; Setareh Salehi Omran; Gino Gialdini; Aaron Gusdon; Benjamin Hartley; David Roh; Halinder S Mangat; Costantino Iadecola; Babak B Navi; Hooman Kamel

doi:10.1212/WNL.0000000000003935

Outcomes after intracerebral hemorrhage from arteriovenous malformations

Neurology. 2017 May 16;88(20):1882-1888. doi: 10.1212/WNL.0000000000003935. Epub 2017 Apr 19.

Affiliations

¹ From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY. sam9200@med.cornell.edu.
² From the Department of Neurology (S.B.M., A.E.M., S.S.O., A.G., H.S.M., C.I., B.B.N., H.K.), Clinical and Translational Neuroscience Unit (S.B.M., A.E.M., G.G., C.I., B.B.N., H.K.), Feil Family Brain and Mind Research Institute, and Department of Neurological Surgery (B.H., H.S.M.), Weill Cornell Medicine; and Department of Neurology (D.R.), Columbia College of Physicians and Surgeons, New York, NY.

Abstract

Objective: To compare outcomes after intracerebral hemorrhage (ICH) from cerebral arteriovenous malformation (AVM) rupture and other causes of ICH.

Methods: We performed a retrospective population-based study using data from the Nationwide Inpatient Sample. We used standard diagnosis codes to identify ICH cases from 2002 to 2011. Our predictor variable was cerebral AVM. Our primary outcomes were inpatient mortality and home discharge. We used logistic regression to compare outcomes between patients with ICH with and without AVM while adjusting for demographics, comorbidities, and hospital characteristics. In a confirmatory analysis using a prospective cohort of patients hospitalized with ICH at our institution, we additionally adjusted for hematoma characteristics and the Glasgow Coma Scale score.

Results: Among 619,167 ICH hospitalizations, the 4,485 patients (0.7%, 95% confidence interval [CI] 0.6-0.8) with an AVM were younger and had fewer medical comorbidities than patients without AVM. After adjustment for confounders, patients with AVM had lower odds of death (odds ratio [OR] 0.5, 95% CI 0.4-0.7) and higher odds of home discharge (OR 2.0, 95% CI 1.4-3.0) than patients without AVM. In a confirmatory analysis of 342 patients with ICH at our institution, the 34 patients (9.9%, 95% CI 7.2-13.6) with a ruptured AVM had higher odds of ambulatory independence at discharge (OR 4.4, 95% CI 1.4-13.1) compared to patients without AVM.

Conclusions: Patients with ICH due to ruptured AVM have more favorable outcomes than patients with ICH from other causes.

MeSH terms

Adult
Aged
Aged, 80 and over
Cerebral Hemorrhage / etiology*
Cerebral Hemorrhage / mortality
Cerebral Hemorrhage / therapy*
Comorbidity
Female
Hospital Mortality
Humans
Intracranial Arteriovenous Malformations / complications*
Intracranial Arteriovenous Malformations / mortality
Intracranial Arteriovenous Malformations / therapy
Logistic Models
Male
Middle Aged
Odds Ratio
Patient Discharge
Prospective Studies
Retrospective Studies
Treatment Outcome
United States

Grants and funding

R01 NS034179/NS/NINDS NIH HHS/United States