Background: Single-center studies suggest that patients with cancer have similar outcomes after intracerebral hemorrhage as compared to patients without cancer. However, these studies were limited by small sample sizes and inclusion of patients with intratumoral hemorrhage. We hypothesized that systemic cancer patients without known brain involvement fare worse after ICH than patients without cancer.
Methods: We used the ICD-9 code 431 to identify all patients diagnosed with spontaneous ICH from 2002 to 2011 in the Nationwide Inpatient Sample. Our predictor variable was systemic cancer; patients with primary brain tumors and known brain metastases were excluded. Our primary outcome was discharge disposition, which was dichotomized into favorable discharge (home/self-care or rehabilitation) or unfavorable discharge (nursing facility, hospice, or death). We used logistic regression to compare the demographics, comorbidities, and outcomes of patients with cancer versus those without cancer. We performed secondary analyses by cancer subtype (i.e., non-metastatic solid tumors, non-metastatic hematologic tumors, and metastatic solid or hematologic tumors).
Results: Our cohort comprised 597,046 ICH patients, among whom 22,394 (3.8%) had systemic cancer. Stroke risk factors such as hypertension and diabetes mellitus were significantly more common in patients without cancer, while anticoagulant use and higher Charlson comorbidity scores were more common amongst cancer patients. In multivariate logistic regression adjusting for demographics, comorbidities, and hospital-level characteristics, patients with cancer had higher odds of death (OR 1.62, 95% CI 1.56-1.69) and lower odds of favorable discharge (OR 0.59, 95% CI 0.56-0.63) than patients without cancer. Our primary results were substantiated in our secondary analysis as patients with cancer did worse than patients without cancer regardless of cancer subtype. Amongst the cancer groups, patients with non-metastatic hematologic tumors and those with metastatic disease fared the worst.
Conclusions: Patients with systemic cancer have higher mortality and less favorable discharge outcomes after ICH than patients without cancer. Cancer subtype may influence outcomes after ICH.