Co-morbidities and mortality associated with intracranial bleeds and ischaemic stroke

Stroke is a leading cause of mortality and acquired disability; however, there has been no comprehensive comparison of co-morbid risk factors between different stroke subtypes. The aim of this study was to compare risk factors and mortality for subdural haematoma (SDH), subarachnoid haemorrhage (SAH) and ischaemic and haemorrhagic stroke. We compiled a database of all patients admitted with these conditions to a large teaching hospital in Birmingham, United Kingdom during the period 2000-2007 using the International Classification of Disease (ICD) 10th revision codes. Generalised linear models were constructed to calculate relative risks (RRs) associated with co-morbidities. In total, 4804 patients were admitted with diagnoses of SDH (1004), SAH (807), ischaemic stroke (2579) and haemorrhagic stroke (414). Patients with SDH were less likely to have pneumonia (0.492, 95% CI, 0.330-0.734; p < 0.001), whereas alcohol abuse (4.21, 95% CI, 2.82-6.28; p < 0.001) was more common. In SAH, ischaemic heart disease (0.56, 95% CI, 0.40-0.79; p < 0.001) was less common. As expected, a range of cardiovascular risk factors were associated with ischaemic stroke. Epilepsy was positively associated with ischaemic stroke (1.94, 95% CI, 1.36-2.76; p < 0.001), indicating a role for targeted primary prevention in patients with epilepsy. Five-year survival was lower in ischaemic and haemorrhagic strokes (41% and 40% respectively, vs. 73% in SDH and 64% in SAH; p < 0.001). These findings may guide clinical risk stratification, and improve the prognostic information given to patients.