Subacute neurological improvement predicts favorable functional recovery after intracerebral hemorrhage: INTERACT2 Study

Shoujiang You; Danni Zheng; Xiaoying Chen; Xia Wang; Menglu Ouyang; Qiao Han; Yongjun Cao; Candice Delcourt; Lili Song; Cheryl Carcel; Hisatomi Arima; Chun-Feng Liu; Richard I. Lindley; Thompson Robinson; Craig S. Anderson; John Chalmers; INTERACT Investigators

doi:10.1161/STROKEAHA.124.048847

Subacute neurological improvement predicts favorable functional recovery after intracerebral hemorrhage: INTERACT2 Study

Shoujiang You, Danni Zheng, Xiaoying Chen, Xia Wang, Menglu Ouyang, Qiao Han, Yongjun Cao, Candice Delcourt, Lili Song, Cheryl Carcel, Hisatomi Arima, Chun-Feng Liu, Richard I. Lindley, Thompson Robinson, Craig S. Anderson, John Chalmers, INTERACT Investigators

Macquarie Medical School

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

BACKGROUND: The frequency and prognostic significance of subacute neurological improvement (SNI) on 90-day outcomes after acute intracerebral hemorrhage are unknown.

METHODS: Secondary analyses of participant data from the INTERACT2 trial (Second Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial). SNI included any, moderate, significant, and substantial neurological improvement defined as ≥1, ≥2, ≥3, and ≥4 points decrease, respectively, on the National Institutes of Health Stroke Scale from 24 hours to 7 days after intracerebral hemorrhage. Logistic regression models were used to assess associations of SNI and death or major disability (modified Rankin Scale score of 3-6), major disability (modified Rankin Scale scores, 3-5), and death alone at 90 days. Data are reported as odds ratios and 95% CIs.

RESULTS: Of 2571 patients included in analyses, 1492 (58.0%), 1057 (41.1%), 731 (28.4%), and 490 (19.1%) patients experienced any, moderate, significant, and substantial SNI (24 hours to 7 days) after intracerebral hemorrhage, respectively. After adjustment for key confounders, any SNI was associated with 49%, 25%, and 65% reduced odds of death or major disability (odds ratio, 0.51 [95% CI, 0.42-0.63]), major disability alone (odds ratio, 0.75 [95% CI, 0.63-0.90]), and death (odds ratio, 0.35 [95% CI, 0.24-0.50]), respectively. Moderate, significant, and substantial SNI were also significantly associated with decreased odds of death or major disability at 90 days. The relationship between any SNI and study outcomes was consistent in most subgroups, including age and baseline hematoma volume. Early intensive blood pressure-lowering treatment did not increase the odds of SNI.

CONCLUSIONS: SNI from 24 hours to 7 days is common after intracerebral hemorrhage and predicts a lower likelihood of death or major disability.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00716079.

Original language	English
Pages (from-to)	621-627
Number of pages	7
Journal	Stroke
Volume	56
Issue number	3
DOIs	https://doi.org/10.1161/STROKEAHA.124.048847
Publication status	Published - Mar 2025

Keywords

blood pressure
cerebral hemorrhage
logistic models
prognosis
stroke

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10.1161/STROKEAHA.124.048847

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You, S., Zheng, D., Chen, X., Wang, X., Ouyang, M., Han, Q., Cao, Y., Delcourt, C., Song, L., Carcel, C., Arima, H., Liu, C.-F., Lindley, R. I., Robinson, T., Anderson, C. S., Chalmers, J., & INTERACT Investigators (2025). Subacute neurological improvement predicts favorable functional recovery after intracerebral hemorrhage: INTERACT2 Study. Stroke, 56(3), 621-627. https://doi.org/10.1161/STROKEAHA.124.048847

@article{fe42aaea1ea94800b506dcb3a005aae8,

title = "Subacute neurological improvement predicts favorable functional recovery after intracerebral hemorrhage: INTERACT2 Study",

abstract = "BACKGROUND: The frequency and prognostic significance of subacute neurological improvement (SNI) on 90-day outcomes after acute intracerebral hemorrhage are unknown.METHODS: Secondary analyses of participant data from the INTERACT2 trial (Second Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial). SNI included any, moderate, significant, and substantial neurological improvement defined as ≥1, ≥2, ≥3, and ≥4 points decrease, respectively, on the National Institutes of Health Stroke Scale from 24 hours to 7 days after intracerebral hemorrhage. Logistic regression models were used to assess associations of SNI and death or major disability (modified Rankin Scale score of 3-6), major disability (modified Rankin Scale scores, 3-5), and death alone at 90 days. Data are reported as odds ratios and 95% CIs.RESULTS: Of 2571 patients included in analyses, 1492 (58.0%), 1057 (41.1%), 731 (28.4%), and 490 (19.1%) patients experienced any, moderate, significant, and substantial SNI (24 hours to 7 days) after intracerebral hemorrhage, respectively. After adjustment for key confounders, any SNI was associated with 49%, 25%, and 65% reduced odds of death or major disability (odds ratio, 0.51 [95% CI, 0.42-0.63]), major disability alone (odds ratio, 0.75 [95% CI, 0.63-0.90]), and death (odds ratio, 0.35 [95% CI, 0.24-0.50]), respectively. Moderate, significant, and substantial SNI were also significantly associated with decreased odds of death or major disability at 90 days. The relationship between any SNI and study outcomes was consistent in most subgroups, including age and baseline hematoma volume. Early intensive blood pressure-lowering treatment did not increase the odds of SNI.CONCLUSIONS: SNI from 24 hours to 7 days is common after intracerebral hemorrhage and predicts a lower likelihood of death or major disability.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00716079.",

keywords = "blood pressure, cerebral hemorrhage, logistic models, prognosis, stroke",

author = "Shoujiang You and Danni Zheng and Xiaoying Chen and Xia Wang and Menglu Ouyang and Qiao Han and Yongjun Cao and Candice Delcourt and Lili Song and Cheryl Carcel and Hisatomi Arima and Chun-Feng Liu and Lindley, {Richard I.} and Thompson Robinson and Anderson, {Craig S.} and John Chalmers and {INTERACT Investigators}",

year = "2025",

month = mar,

doi = "10.1161/STROKEAHA.124.048847",

language = "English",

volume = "56",

pages = "621--627",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams & Wilkins",

number = "3",

}

You, S, Zheng, D, Chen, X, Wang, X, Ouyang, M, Han, Q, Cao, Y, Delcourt, C, Song, L, Carcel, C, Arima, H, Liu, C-F, Lindley, RI, Robinson, T, Anderson, CS, Chalmers, J & INTERACT Investigators 2025, 'Subacute neurological improvement predicts favorable functional recovery after intracerebral hemorrhage: INTERACT2 Study', Stroke, vol. 56, no. 3, pp. 621-627. https://doi.org/10.1161/STROKEAHA.124.048847

TY - JOUR

T1 - Subacute neurological improvement predicts favorable functional recovery after intracerebral hemorrhage

T2 - INTERACT2 Study

AU - You, Shoujiang

AU - Zheng, Danni

AU - Chen, Xiaoying

AU - Wang, Xia

AU - Ouyang, Menglu

AU - Han, Qiao

AU - Cao, Yongjun

AU - Delcourt, Candice

AU - Song, Lili

AU - Carcel, Cheryl

AU - Arima, Hisatomi

AU - Liu, Chun-Feng

AU - Lindley, Richard I.

AU - Robinson, Thompson

AU - Anderson, Craig S.

AU - Chalmers, John

AU - INTERACT Investigators

PY - 2025/3

Y1 - 2025/3

N2 - BACKGROUND: The frequency and prognostic significance of subacute neurological improvement (SNI) on 90-day outcomes after acute intracerebral hemorrhage are unknown.METHODS: Secondary analyses of participant data from the INTERACT2 trial (Second Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial). SNI included any, moderate, significant, and substantial neurological improvement defined as ≥1, ≥2, ≥3, and ≥4 points decrease, respectively, on the National Institutes of Health Stroke Scale from 24 hours to 7 days after intracerebral hemorrhage. Logistic regression models were used to assess associations of SNI and death or major disability (modified Rankin Scale score of 3-6), major disability (modified Rankin Scale scores, 3-5), and death alone at 90 days. Data are reported as odds ratios and 95% CIs.RESULTS: Of 2571 patients included in analyses, 1492 (58.0%), 1057 (41.1%), 731 (28.4%), and 490 (19.1%) patients experienced any, moderate, significant, and substantial SNI (24 hours to 7 days) after intracerebral hemorrhage, respectively. After adjustment for key confounders, any SNI was associated with 49%, 25%, and 65% reduced odds of death or major disability (odds ratio, 0.51 [95% CI, 0.42-0.63]), major disability alone (odds ratio, 0.75 [95% CI, 0.63-0.90]), and death (odds ratio, 0.35 [95% CI, 0.24-0.50]), respectively. Moderate, significant, and substantial SNI were also significantly associated with decreased odds of death or major disability at 90 days. The relationship between any SNI and study outcomes was consistent in most subgroups, including age and baseline hematoma volume. Early intensive blood pressure-lowering treatment did not increase the odds of SNI.CONCLUSIONS: SNI from 24 hours to 7 days is common after intracerebral hemorrhage and predicts a lower likelihood of death or major disability.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00716079.

AB - BACKGROUND: The frequency and prognostic significance of subacute neurological improvement (SNI) on 90-day outcomes after acute intracerebral hemorrhage are unknown.METHODS: Secondary analyses of participant data from the INTERACT2 trial (Second Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial). SNI included any, moderate, significant, and substantial neurological improvement defined as ≥1, ≥2, ≥3, and ≥4 points decrease, respectively, on the National Institutes of Health Stroke Scale from 24 hours to 7 days after intracerebral hemorrhage. Logistic regression models were used to assess associations of SNI and death or major disability (modified Rankin Scale score of 3-6), major disability (modified Rankin Scale scores, 3-5), and death alone at 90 days. Data are reported as odds ratios and 95% CIs.RESULTS: Of 2571 patients included in analyses, 1492 (58.0%), 1057 (41.1%), 731 (28.4%), and 490 (19.1%) patients experienced any, moderate, significant, and substantial SNI (24 hours to 7 days) after intracerebral hemorrhage, respectively. After adjustment for key confounders, any SNI was associated with 49%, 25%, and 65% reduced odds of death or major disability (odds ratio, 0.51 [95% CI, 0.42-0.63]), major disability alone (odds ratio, 0.75 [95% CI, 0.63-0.90]), and death (odds ratio, 0.35 [95% CI, 0.24-0.50]), respectively. Moderate, significant, and substantial SNI were also significantly associated with decreased odds of death or major disability at 90 days. The relationship between any SNI and study outcomes was consistent in most subgroups, including age and baseline hematoma volume. Early intensive blood pressure-lowering treatment did not increase the odds of SNI.CONCLUSIONS: SNI from 24 hours to 7 days is common after intracerebral hemorrhage and predicts a lower likelihood of death or major disability.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00716079.

KW - blood pressure

KW - cerebral hemorrhage

KW - logistic models

KW - prognosis

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=85216965504&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.124.048847

DO - 10.1161/STROKEAHA.124.048847

M3 - Article

C2 - 39895502

AN - SCOPUS:85216965504

SN - 0039-2499

VL - 56

SP - 621

EP - 627

JO - Stroke

JF - Stroke

IS - 3

ER -

Subacute neurological improvement predicts favorable functional recovery after intracerebral hemorrhage: INTERACT2 Study

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