Functional trajectories between 90 days and 1 year after intracerebral haemorrhage: a Swedish Stroke Register (Riksstroke) study.
5 affiliations
- 1Department of Neurology, Skåne University Hospital, Lund, Sweden.
- 2Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- 3Department of Radiology, Skåne University Hospital, Lund, Sweden.
- 4Stroke Imaging Research Group, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- 5Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Abstract
Introduction
Functional outcome after ICH is commonly assessed at 90 days, although recovery and deterioration may continue beyond this conventional endpoint. Large-scale data describing within-patient functional trajectories beyond 90 days remain limited.Patients and methods
We conducted a register-based cohort study using the Swedish Stroke Register (Riksstroke), including adults with ICH between 2017 and 2021. Prestroke-independent 90-day survivors with available mRS data at both 90 days and 1 year were included. Functional trajectories were classified as improved, unchanged, worsened or died according to transitions across grouped mRS categories (0-2, 3, 4, 5 and 6 [death]). Multivariable logistic regression identified predictors of worsening or death and improvement.Results
Among 13,574 patients with ICH, 8583 prestroke-independent patients fulfilled eligibility criteria. Of these, 4797 were alive with available 90-day mRS data, and 3030 had complete mRS assessments at both 90 days and 1 year and were included in the primary analysis. Between 90 days and 1 year, 21.5% improved, 67.6% remained unchanged, 5.2% worsened and 5.8% died. Recovery at 1 year was most frequent among patients with mRS 3 at 90 days, of whom 62.4% achieved mRS 0-2, whereas 92.8% of patients with mRS 0-2 remained in the same category. Among patients with mRS 4-5 at 90 days, 20.4% improved to mRS 0-3 by 1 year. Increasing age and higher 90-day disability were associated with less favourable trajectories, whereas male sex was associated with greater likelihood of improvement.Conclusion
Among prestroke-independent 90-day survivors with complete functional follow-up, functional outcomes after ICH remained dynamic beyond 90 days, particularly among patients with moderate disability. Nearly two-thirds of patients with moderate disability at 90 days achieved mRS 0-2 by 1 year, whereas more than 9 in 10 patients who were already classified as mRS 0-2 remained so. These findings suggest that longer-term outcome assessment may provide additional clinically relevant information in future ICH studies and clinical trials.
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BibTeX
@article{johnsson2026functional,
title = {{Functional trajectories between 90 days and 1 year after intracerebral haemorrhage: a Swedish Stroke Register (Riksstroke) study.}},
author = {Marcus Johnsson and Björn M Hansen and Trine Apostolaki-Hansson and Mats Pihlsgård and Bo Norrving and Teresa Ullberg},
journal = {European stroke journal},
year = {2026},
month = oct,
doi = {10.1093/esj/aakag129},
url = {https://europepmc.org/article/MED/42949837},
note = {CC BY},
}
RIS
TY - JOUR
TI - Functional trajectories between 90 days and 1 year after intracerebral haemorrhage: a Swedish Stroke Register (Riksstroke) study.
AU - Marcus Johnsson
AU - Björn M Hansen
AU - Trine Apostolaki-Hansson
AU - Mats Pihlsgård
AU - Bo Norrving
AU - Teresa Ullberg
PY - 2026
DA - 2026/10/01
JO - European stroke journal
DO - 10.1093/esj/aakag129
UR - https://europepmc.org/article/MED/42949837
AB - Introduction Functional outcome after ICH is commonly assessed at 90 days, although recovery and deterioration may continue beyond this conventional endpoint. Large-scale data describing within-patient functional trajectories beyond 90 days remain limited.Patients and methods We conducted a register-based cohort study using the Swedish Stroke Register (Riksstroke), including adults with ICH between 2017 and 2021. Prestroke-independent 90-day survivors with available mRS data at both 90 days and 1 year were included. Functional trajectories were classified as improved, unchanged, worsened or died according to transitions across grouped mRS categories (0-2, 3, 4, 5 and 6 [death]). Multivariable logistic regression identified predictors of worsening or death and improvement.Results Among 13,574 patients with ICH, 8583 prestroke-independent patients fulfilled eligibility criteria. Of these, 4797 were alive with available 90-day mRS data, and 3030 had complete mRS assessments at both 90 days and 1 year and were included in the primary analysis. Between 90 days and 1 year, 21.5% improved, 67.6% remained unchanged, 5.2% worsened and 5.8% died. Recovery at 1 year was most frequent among patients with mRS 3 at 90 days, of whom 62.4% achieved mRS 0-2, whereas 92.8% of patients with mRS 0-2 remained in the same category. Among patients with mRS 4-5 at 90 days, 20.4% improved to mRS 0-3 by 1 year. Increasing age and higher 90-day disability were associated with less favourable trajectories, whereas male sex was associated with greater likelihood of improvement.Conclusion Among prestroke-independent 90-day survivors with complete functional follow-up, functional outcomes after ICH remained dynamic beyond 90 days, particularly among patients with moderate disability. Nearly two-thirds of patients with moderate disability at 90 days achieved mRS 0-2 by 1 year, whereas more than 9 in 10 patients who were already classified as mRS 0-2 remained so. These findings suggest that longer-term outcome assessment may provide additional clinically relevant information in future ICH studies and clinical trials.
SN - 2396-9873
SN - 2396-9881
ER -