Functional outcome after ischaemic stroke and intracerebral haemorrhage from two national cohorts

Background Outcome of acute ischaemic stroke (AIS) improved considerably through intravenous thrombolysis (IVT) and endovascular therapy (EVT), while treatment options for intracerebral haemorrhage (ICH) remained limited. We compared functional outcome 3 months after AIS and ICH in contemporary patients from two national stroke registries. Methods This is a pooled analysis of the prospective Swiss and Norwegian Stroke Registries. We enrolled all patients with AIS and ICH between 2014 and 2022/2023. The primary outcome was favourable functional outcome (modified Rankin Scale 0–2) at 3 months. Results We included 111 038 patients: 98 354 patients with AIS (21 946/22.4% patients received IVT and 8270/8.4% patients received EVT) and 12 684 patients with ICH. Baseline National Institutes of Health Stroke Scale (NIHSS) was higher in patients with ICH (AIS: median 3, IQR 1–7 vs ICH median 7, IQR 2–15). Overall, 64 135 patients with AIS (65.2%) and 4620 patients with ICH (36.4%) had a favourable functional outcome. ICH was independently associated with poor outcome (adjusted OR (aOR) for favourable functional outcome: 0.42, 95% CI 0.39 to 0.45, p<0.001). Sensitivity analysis excluding patients receiving IVT/EVT confirmed the finding with attenuated magnitude (aOR 0.61, 95% CI 0.56 to 0.66, p<0.001). GSEM analysis found a significant negative direct (β-coefficient −0.77) and indirect effect of ICH on outcome. The indirect effect was mediated through higher baseline NIHSS (β-coefficient=+4.55) and availability of IVT/EVT for AIS (β-coefficient=−21.74 and −22.11, respectively). Overall, the effect of ICH on outcome was split between direct (47%) and indirect (53%) effects. Conclusion Functional outcome after ICH is worse compared with AIS. Measured clinical mediators only partly explain the differences and unmeasured overall care directions (ie, care limitations) may have contributed.

Authors

Institutions

Publication Details

Journal
Journal of Neurology Neurosurgery & Psychiatry
Published
2026-10-13
DOI
https://doi.org/10.1136/jnnp-2026-339655
Primary Topic
Acute Ischemic Stroke Management
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Functional outcome after ischaemic stroke and intracerebral haemorrhage from two national cohorts

Bernhard Siepen, Yasaman Safarkhanlo, Martina Goeldlin, Alexandros A. Polymeris et al.
Journal of Neurology Neurosurgery & Psychiatry
Acute Ischemic Stroke Management
article

Functional outcome after ischaemic stroke and intracerebral haemorrhage from two national cohorts

Bernhard Siepen, Yasaman Safarkhanlo, Martina Goeldlin, Alexandros A. Polymeris, Melinda Berg Roaldsen, Susanne Renaud, Johannes Kaesmacher, Annette Fromm, M-L Mono, Silje Holt Jahr, Adnan Mujanović, Davide Strambo, Manuel Bolognese, Fredrik Ildstad, Espen Saxhaug Kristoffersen, Anette Huuse Farmen, Christophe Bonvin, Julien Niederhäuser, Werner Josef Z'Graggen, Emmanuel Carrera, Alexander Andrea Tarnutzer, Arnstein Tveiten, Thomas R. Meinel, Agnethe Eltoft, David Julian Seiffge, Bastian Volbers, Timo Kahles, Susanne Wegener, ΜΙΧΑΗΛ ΓΙΑΝΝΑΚΑΚΗΣ, Else Charlotte Sandset, Trine Lied-Herland, Carlo Cereda, Soffien Ajmi, Marta Garés Caballer, Urs Fischer, Isabel Charlotte Hostettler, Greta Soekeland, Marcel Arnold, Elias Auer, Friedrich Medlin, Pamela Correia, Nils Peters, Ole Morten Rønning, Janis Rauch, Mira Katan, Stefan Engelter, Maria Carlsson
article en

Abstract

Background Outcome of acute ischaemic stroke (AIS) improved considerably through intravenous thrombolysis (IVT) and endovascular therapy (EVT), while treatment options for intracerebral haemorrhage (ICH) remained limited. We compared functional outcome 3 months after AIS and ICH in contemporary patients from two national stroke registries. Methods This is a pooled analysis of the prospective Swiss and Norwegian Stroke Registries. We enrolled all patients with AIS and ICH between 2014 and 2022/2023. The primary outcome was favourable functional outcome (modified Rankin Scale 0–2) at 3 months. Results We included 111 038 patients: 98 354 patients with AIS (21 946/22.4% patients received IVT and 8270/8.4% patients received EVT) and 12 684 patients with ICH. Baseline National Institutes of Health Stroke Scale (NIHSS) was higher in patients with ICH (AIS: median 3, IQR 1–7 vs ICH median 7, IQR 2–15). Overall, 64 135 patients with AIS (65.2%) and 4620 patients with ICH (36.4%) had a favourable functional outcome. ICH was independently associated with poor outcome (adjusted OR (aOR) for favourable functional outcome: 0.42, 95% CI 0.39 to 0.45, p<0.001). Sensitivity analysis excluding patients receiving IVT/EVT confirmed the finding with attenuated magnitude (aOR 0.61, 95% CI 0.56 to 0.66, p<0.001). GSEM analysis found a significant negative direct (β-coefficient −0.77) and indirect effect of ICH on outcome. The indirect effect was mediated through higher baseline NIHSS (β-coefficient=+4.55) and availability of IVT/EVT for AIS (β-coefficient=−21.74 and −22.11, respectively). Overall, the effect of ICH on outcome was split between direct (47%) and indirect (53%) effects. Conclusion Functional outcome after ICH is worse compared with AIS. Measured clinical mediators only partly explain the differences and unmeasured overall care directions (ie, care limitations) may have contributed.

Journal of Neurology Neurosurgery & Psychiatry
University of Bern (CH), Oslo University Hospital (NO), University Hospital of North Norway (NO), University of Oslo (NO), University of Basel (CH), University of Zurich (CH), University of St.Gallen (CH), Norwegian University of Science and Technology (NO), Innlandet Hospital Trust (NO), Stavanger University Hospital (NO), Akershus University Hospital (NO), Haukeland University Hospital (NO), University Hospital of Bern (CH), Nordland Hospital Trust (NO), University Hospital of Basel (CH), Hospital of Southern Norway (NO), University of Oxford (GB), Ospedale regionale di Lugano (CH), Klinik Hirslanden (CH), University Hospital of Zurich (CH), St Olav's University Hospital (NO), Fribourg Development Agency (CH), Hospital Neuchâtel (CH), University Hospital of Geneva (CH), Felix Platter-Hospital (CH), Luzerner Kantonsspital (CH), Kantonsspital Baden (CH), Stadtspital Waid (CH), Hôpital de Sion (CH), Kantonsspital Aarau (CH), Hôpital du Valais (CH), Technical University of Munich (DE), UiT The Arctic University of Norway (NO), University of Lausanne (CH)
Openalex Percentile: Top 13%
Acute Ischemic Stroke Management
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.