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Mortalité et déclin fonctionnel au long cours des patients après une hémorragie intracérébrale spontanée

Abstract : Background: Spontaneous (non-traumatic) intracerebral hemorrhage (ICH) is the most dramatic type of stroke being responsible for the majority of short-term mortality and stroke-related disability. The main objective of this thesis was to determine among ICH survivors: (i) rate of mortality and frequency of functional decline after ICH; (ii) clinical and radiological predictors of long-term mortality and functional decline; (iii) the influence of major clinical events during follow-up on long-term mortality and functional decline.Methods: We included all consecutive ICH patients admitted at the Lille University Hospital for spontaneous ICH between 2004 and 2009 prospectively enrolled in the observational PITCH (Prognosis of IntraCerebral Haemorrhage) study.Results: In ICH survivors, the cumulative survival rate at 10 years was 38 %. During a median follow-up of 9 years, 23 % of patients experienced a functional decline. In multivariable analysis, variables independently associated with long-term mortality were age, male gender, prestroke dependency, ICH clinical severity at presentation, occurrence of any stroke, and dementia during follow-up. Among MRI markers, only cerebral atrophy was independently associated with long-term mortality. Functional decline after ICH was independently associated with age, ICH volume, functional status at 6 months, occurrence of major clinical event during follow-up.Conclusion: The results of this work have an important clinical impact. They underline the relevance of long-term follow-up in patients with ICH. They provide new insights on the risk of mortality and functional decline as well as on their associated predictors.
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Submitted on : Wednesday, October 27, 2021 - 2:29:47 PM
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Marco Pasi. Mortalité et déclin fonctionnel au long cours des patients après une hémorragie intracérébrale spontanée. Médecine humaine et pathologie. Université de Lille, 2021. Français. ⟨NNT : 2021LILUS019⟩. ⟨tel-03405857⟩

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