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Publications

Journal Article Ppublish

PubMed: 42378499 DOI: 10.1093/esj/aakag040

Clinical characteristics and outcomes of intracerebral haemorrhage in young vs older adults: insights from the INTERACT3 trial.

Eur Stroke J 11(6)

Authors: Maria Khan, Menglu Ouyang, Mohammad Wasay, Lu Ma, Xin Hu, Xiaoying Chen, Laurent Billot, Qiang Li, Paula Muñoz Venturelli, Asita de Silva, Nguyen Huy Thang, Kolawole W Wahab, Jeyaraj D Pandian, Octavio M Pontes-Neto, Carlos Abanto, Antonio Arauz, Chao You, Lili Song, Craig S Anderson

Affiliations

  • Department of Neurology, Rashid Hospital, Dubai, UAE.
  • Department of Neurology, Mohammed bin Rashid University of Medical and Health Sciences, Dubai, UAE.
  • The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
  • Department of Medicine, The Aga Khan University, Karachi, Pakistan.
  • Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
  • Clinical Research Center, Faculty of Medicine, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.
  • Clinical Trials Unit, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka.
  • Stroke Unit, Gia An 115 Hospital, Ho Chi Minh City, Vietnam.
  • Department of Medicine, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Nigeria.
  • Neurology Department, Christian Medical College and Hospital, Ludhiana, India.
  • Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil.
  • Cerebrovascular Disease Research Center, National Institute of Neurological Sciences, Lima, Peru.
  • Department of Neurology, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico.
  • Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China.
  • Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.
  • Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.

Abstract

INTRODUCTION

ICH is a severe form of stroke with increasing global burden. Although more common in older adults, ICH in younger individuals (≤50 years) is a clinically distinct but understudied subgroup. This secondary analysis of the INTERACT3 trial compared baseline characteristics, management and outcomes between younger and older ICH patients.

PATIENTS AND METHODS

INTERACT3 was a stepped-wedge, cluster-randomised trial conducted in 122 hospitals across 10 countries (2017-2021), evaluating a bundled care intervention for acute ICH. This sub-study analysed 7031 patients and compared demographics, imaging features, in-hospital treatment and 6-month outcomes between age groups. Primary outcomes were functional status (mRS), mortality and quality of life (EQ-5D-3L). Outcomes were analysed using generalised linear-mixed models accounting for clustering by hospital (random effect) and fixed effects for time period and cluster treatment assignment, with additional adjustment for pre-specified patient-level covariates.

RESULTS

Of 7031 patients, 1351 (19.2%) were aged ≤ 50 years. Younger patients were more often male (70.8% vs 62.4%, P < .0001), had higher body mass index (BMI) (25.3 vs 23.8 kg/m2, P < .0001) and were more likely to smoke (36.1% vs 21.4%) and consume alcohol (33.2% vs 13.3%). Despite having slightly larger haematoma volumes (18.0 vs 15.0 mL, P < .0001), younger patients had significantly better outcomes, with lower 6-month mortality (9.1% vs 16.6%; adjusted OR 0.42; 95% CI, 0.33-0.54) and reduced rates of death or disability (46.5% vs 57.8%; OR 0.56; 95% CI, 0.48-0.65). A significant age-by-treatment interaction was observed (P = .0251).

CONCLUSION

Younger ICH patients demonstrated a distinct risk profile and better recovery, and benefiting more from bundled care interventions. These findings highlight the importance of early, intensive management and tailored prevention strategies targeting modifiable lifestyle risks in younger populations.

MeSH

Mortality, Stroke, Therapeutics