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(Stroke. 2009;40:2068.)
© 2009 American Heart Association, Inc.

Original Contributions

Hemorrhagic and Ischemic Strokes Compared

Stroke Severity, Mortality, and Risk Factors

Klaus Kaae Andersen, MS, PhD; Tom Skyhøj Olsen, MD, PhD; Christian Dehlendorff, MS Lars Peter Kammersgaard, MD

From Informatics and Mathematical Modelling (K.K.A., C.D.), Section for Statistics, Technical University of Denmark, Lyngby; The Stroke Unit (T.S.O., L.P.K.), Hvidovre University Hospital, Hvidovre, Denmark.

Correspondence to Tom Skyhøj Olsen, MD, PhD, The Stroke Unit, Dept. of Neurorehabilitation, Hvidovre University Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark. E-mail skyhoj.olsen{at}dadlnet.dk

Background and Purpose— Stroke patients with hemorrhagic (HS) and ischemic strokes were compared with regard to stroke severity, mortality, and cardiovascular risk factors.

Methods— A registry started in 2001, with the aim of registering all hospitalized stroke patients in Denmark, now holds information for 39 484 patients. The patients underwent an evaluation including stroke severity (Scandinavian Stroke Scale), CT, and cardiovascular risk factors. They were followed-up from admission until death or censoring in 2007. Independent predictors of death were identified by means of a survival model based on 25 123 individuals with a complete data set.

Results— Of the patients 3993 (10.1%) had HS. Stroke severity was almost linearly related to the probability of having HS (2% in patients with the mildest stroke and 30% in those with the most severe strokes). Factors favoring ischemic strokes vs HS were diabetes, atrial fibrillation, previous myocardial infarction, previous stroke, and intermittent arterial claudication. Smoking and alcohol consumption favored HS, whereas age, sex, and hypertension did not herald stroke type. Compared with ischemic strokes, HS was associated with an overall higher mortality risk (HR, 1.564; 95% CI, 1.441–1.696). The increased risk was, however, time-dependent; initially, risk was 4-fold, after 1 week it was 2.5-fold, and after 3 weeks it was 1.5-fold. After 3 months stroke type did not correlate to mortality.

Conclusion— Strokes are generally more severe in patients with HS. Within the first 3 months after stroke, HS is associated with a considerable increase of mortality, which is specifically associated with the hemorrhagic nature of the lesion.

Key Words: cerebral infarct • intracerebral hemorrhage • mortality • risk factors • stroke recovery