Modelling dynamic transitions in neurological functional disability in patients with intracerebral haemorrhage: a prospective cohort study using a multistate Markov model

Abstract

Objectives This study aims to explore the dynamics of neurological functional disability in patients with intracerebral haemorrhage (ICH) using a multistate Markov model and to investigate the factors influencing the shift in neurological functional disability.Design A prospective cohort study.Setting Electronic medical record data for adults, from July 2019 and October 2023 in neurosurgery at 27 national centres in China.Participants Patients with ICH with cerebral haemorrhage in the supratentorial parenchyma confirmed by CT of the brain within 48 hours of onset of symptoms. Secondary cerebral haemorrhage due to aneurysm, vascular malformation, haemorrhagic infarction, tumour or coagulation disorders was excluded.Primary and secondary outcome measures Participants evaluated neurological functional status through the modified Rankin Scale, which we graded to construct a multistate Markov model.Results After treatment, patients with ICH who achieve good recovery of neurological function are 2.66 times more likely to transition to a state of no neurological impairment than to severe impairment. Patients in states of no neurological impairment and mild impairment tend to remain relatively stable, while those with severe impairment are at higher risk of transitioning to states that could result in mortality. A person with no disability post-ICH can expect to spend 19.42 (12.87~29.30) months in that state, and 9.99 (8.39~11.89) months in state S2 and 8.87 (7.79~10.09) months in state 3 during their lifetime.Conclusions In the year following treatment and discharge, the neurological functional disability of most patients with ICH tends to remain stable. For patients undergoing state transitions, the probability of neurological improvement is higher than the likelihood of deterioration. Risk factors associated with deterioration include advanced age, preonset neurological impairment, a history of cerebrovascular disease, larger haematoma volume, and critical conditions. Patients with these risk factors should receive close monitoring after discharge.