Distinctive mortality patterns and the survival paradox in intracerebral haemorrhage subtypes: a 15-year longitudinal study.
JD, L., CH, L., TY, C., KL, H., YC, C., & TH, L. (2026). Distinctive mortality patterns and the survival paradox in intracerebral haemorrhage subtypes: a 15-year longitudinal study.. European stroke journal. https://doi.org/10.1093/esj/aakag097
JD L, CH L, TY C, KL H, YC C, TH L. Distinctive mortality patterns and the survival paradox in intracerebral haemorrhage subtypes: a 15-year longitudinal study.. European stroke journal. 2026; doi: 10.1093/esj/aakag097
JD L, CH L, TY C, et al. Distinctive mortality patterns and the survival paradox in intracerebral haemorrhage subtypes: a 15-year longitudinal study.[J]. European stroke journal. 2026. DOI: 10.1093/esj/aakag097.
@article{jd2026,
author = {Lee JD and Liu CH and Chang TY and Huang KL and Chou YC and Lee TH},
title = {Distinctive mortality patterns and the survival paradox in intracerebral haemorrhage subtypes: a 15-year longitudinal study.},
journal = {European stroke journal},
year = {2026},
doi = {10.1093/esj/aakag097},
note = {PMID: 42611715},
}
TY - JOUR AU - Lee JD AU - Liu CH AU - Chang TY AU - Huang KL AU - Chou YC AU - Lee TH TI - Distinctive mortality patterns and the survival paradox in intracerebral haemorrhage subtypes: a 15-year longitudinal study. T2 - European stroke journal PY - 2026 DO - 10.1093/esj/aakag097 AN - PMID:42611715 ER -
INTRODUCTION: We investigated long-term outcomes, survival trajectories and cause-specific mortality in intracerebral haemorrhage (ICH) subtypes stratified by aetiology, location and recurrence status. PATIENTS AND METHODS: This retrospective cohort study analysed 15,186 nontraumatic ICH patients enrolled in the multi-centre Stroke Registry of the Chang-Gung Healthcare System (SRICHS) in Taiwan (2007-2018). Registry data were linked to the Chang Gung Research Databank (clinical data, 2007-2018), the National Health Insurance Research Databank (longitudinal comorbidities, 2007-2022) and the Taiwan Death Registry (cause of death, 2007-2022). Patients were stratified into 4 subtypes: hypertensive (deep) ICH (first-ever = HICH-F and recurrent = HICH-R) and non-hypertensive including lobar ICH (first-ever = NHICH-F and recurrent = NHICH-R). RESULTS: Hypertensive ICH patients had a higher burden of metabolic risk factors compared to NHICH. A distinct "survival paradox" was observed in the NHICH-F group: despite having the highest initial stroke severity and 30-day mortality (22.9%, lobar = 19.5%), survivors demonstrated the best long-term survival probability among all subtypes. Conversely, HICH-F patients had the highest rate of subsequent ICH recurrence (50.5%). Recurrent ICH groups (HICH-R/NHICH-R) had the highest overall mortality (~66%), driven significantly by pneumonia and diabetes. While stroke was the most common primary cause of death across all groups, cancer was the second most common primary cause in first-ever ICH, whereas infectious and metabolic causes drove mortality in recurrent cases. CONCLUSION: Long-term ICH prognosis is highly heterogeneous. First-ever non-hypertensive ICH carries high acute lethality but favourable long-term survival for 30-day survivors. In contrast, hypertensive and recurrent subtypes face a continuous risk of vascular events and comorbidity-related mortality.