Risk factors impact on the long-term survival after hemorrhagic stroke.

Aim: To analyze the impact of risk factors on the survival rate within a period of five years after hemorrhagic stroke (HS).

Patients And Methods: In this study 303 patients were analyzed with a first ever hemorrhagic stroke admitted at the Department of Neurology Tuzla, from January 1st 1997 to December 31st 1998. Data were collected from patient's medical records, whereas the final examination of all patients, who survived HS, took place five years after stroke. Medical history was obtained and presence of risk factors was evaluated on the day of admission. Computed tomography (CT) of the brain was performed in all patients during hospitalization. The average age of patients was 62 +/- 11 (from 31 to 90) years, 180 (59%) were women. The most frequent risk factor was hypertension, registered in 252 (83%) patients, followed by history of heart diseases in 182 patients (60%), smoking in 72 (23.8%), diabetes mellitus in 26 (8.5%), history of transient ischemic attack in 24 (8%) and alcohol intake in 13 (4.3%) patients. The risk factors were not registered in 22 (7.3%) patients.

Results: Five years after HS 82 (26.7%) patients survived. No statistical significance was found in survival between men and women (p = 0.2). The lowest number of patient that survived were over 70 years old (9%), while the highest number of survived was between 41-50 years (60.5%). The average number of risk factors was 2.5 +/- 1.0 and significantly higher in men compared to women (2.7 +/- 1 : 2.3 +/- 1) (p < 0.001). Significant difference was found in patients with hypertension (n = 252) (p < 0.0001), alcohol intake (n = 13) (p = 0.0170), as well as in patients with diabetes mellitus (n = 26) (p = 0.005). Regarding other risk factors such as heart diseases, cigarette smoking and transient ischemic attack there were no significant difference in survival in patients with hemorrhagic stroke (p = 0.2; p = 0.7; p = 0.8; retrospectively).

Conclusion: We found that hemorrhagic stroke is associated with a very high risk for death in the acute and subacute phase. The survival rate after hemorrhagic stroke was 26.7% within a period of five years. Long-term survival rate prognosis is significantly better among the younger patients, without hypertension, alcohol intake and diabetes mellitus.