Observational studyEuropean stroke journal2026
Distinctive mortality patterns and the survival paradox in intracerebral haemorrhage subtypes: a 15-year longitudinal study.
Observational study in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionWe investigated long-term outcomes, survival trajectories and cause-specific mortality in intracerebral haemorrhage (ICH) subtypes stratified by aetiology, location and recurrence status. PATIENTS AND
methodsThis retrospective cohort study analysed 15,186 nontraumatic ICH patients enrolled in the multi-centre Stroke Registry of the Chang-Gung Healthcare System (SRICHS) in Taiwan (2007-2018). Registry data were linked to the Chang Gung Research Databank (clinical data, 2007-2018), the National Health Insurance Research Databank (longitudinal comorbidities, 2007-2022) and the Taiwan Death Registry (cause of death, 2007-2022). Patients were stratified into 4 subtypes: hypertensive (deep) ICH (first-ever = HICH-F and recurrent = HICH-R) and non-hypertensive including lobar ICH (first-ever = NHICH-F and recurrent = NHICH-R).
resultsHypertensive ICH patients had a higher burden of metabolic risk factors compared to NHICH. A distinct "survival paradox" was observed in the NHICH-F group: despite having the highest initial stroke severity and 30-day mortality (22.9%, lobar = 19.5%), survivors demonstrated the best long-term survival probability among all subtypes. Conversely, HICH-F patients had the highest rate of subsequent ICH recurrence (50.5%). Recurrent ICH groups (HICH-R/NHICH-R) had the highest overall mortality (~66%), driven significantly by pneumonia and diabetes. While stroke was the most common primary cause of death across all groups, cancer was the second most common primary cause in first-ever ICH, whereas infectious and metabolic causes drove mortality in recurrent cases.
conclusionLong-term ICH prognosis is highly heterogeneous. First-ever non-hypertensive ICH carries high acute lethality but favourable long-term survival for 30-day survivors. In contrast, hypertensive and recurrent subtypes face a continuous risk of vascular events and comorbidity-related mortality.
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