Baseline characteristics, in-hospital outcomes and time variances of intracerebral hemorrhage in China: Based on a national, large-scale registry cohort

To the Editor: Intracerebral hemorrhage (ICH) is associated with significantly higher mortality in China1 relative to ischemic stroke. China has a higher incidence of ICH than Europe and the America;2 however, few studies have detailed the disease burden of ICH in China, especially data regarding clinical characteristics during hospitalization. As such, the present study aimed to investigate and analyze the clinical characteristics of patients with ICH during hospitalization and variations in time trends between 2015 and 2022. The Chinese Stroke Center Alliance (CSCA) was initiated as a quality improvement program in secondary and tertiary hospitals in China. All physicians undergo a standard training program before data collection. This study was approved by the Ethics Committee of Beijing Tiantan Hospital (No. KY2018-061-02), and the requirement for individual consent was waived due to its retrospective nature. The present study only included data from patients diagnosed with ICH (including both primary hypertensive, cerebral amyloid angiopathy and secondary due to structural vascular lesions, medication, and so on ICH); as such, those diagnosed with ischemic stroke, transient ischemic attack (TIA), or subarachnoid hemorrhage (SAH) were excluded, along with those diagnosed with an unclassified stroke. Patients were also excluded if key data were incomplete, including age, surgical intervention, and/or geographical region. Study outcomes included in-hospital mortality, death, discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), and in-hospital complications. MACEs were defined as ischemic stroke, hemorrhagic stroke, TIA, or myocardial infarction. Categorical variables are expressed as numbers (percentage) and numerical variables are expressed as mean ± standard deviation (SD) or median (interquartile range IQR). Categorical variables were compared using the chi-squared test or Fisher's exact test. The Student's t-test was used for numerical variables with a normal distribution. Nonparametric tests were used for variables with skewed distributions. Considering the extensive sample size, using an absolute standardized difference ≥10 was more appropriate than P 1,000,000) in the CSCA program, long-term follow-up is impractical for hospital clinicians, and the primary care physician system is not well developed in China. Second, some imaging data, such as hematoma size and peri-hematoma volume, were not collected in the CSCA program due to variability in measurement methods and imaging equipment. In conclusion, our national analysis highlights the clinical characteristics and outcomes of ICH in China, indicating increased in-hospital mortality and rates of DAMA, from 2015 to 2022. Funding This work was supported by grants from the National Natural Science Foundation (Nos. 82401452, 82371302, and 82471489), Beijing Municipal Postdoctoral Work Funding Support (No. 2024-68-167), Beijing Municipal Health Commission's Excellence Clinical Research Program for Research-Oriented Wards Project (No. BRWEP2024W022040100), Noncommunicable Chronic Diseases-National Science and Technology Major Project (No. 2023ZD0504700), Ministry of Finance of the People's Republic of China (issued by Finance and Social Security 2015 No. 82; 2016 No. 50; 2017 No. 72; 2018 No. 48; 2019 No. 77; 2020 No. 75; 2021 No. 84, Ministry of Finance), risk factors and assessment techniques for brain aging (No. HX-A-2023037), and Beijing Scholar (No. 097). Conflicts of interest None.