Risk factors of intracerebral hemorrhage among the young population in Qatar: Are genetic risk factors involved?

Abstract

Background: Intracerebral hemorrhage (ICH) has not been widely investigated in young adults. This study aims to describe the risk factors of ICH with a focus on the possible effect of non-modifiable risk factors, such as genetic factors, to assess the ICH outcomes, and to identify the prognostic factors after ICH among young adult patients. Methods: This prospective and observational study was conducted at two hospitals at Hamad Medical Corporation, Qatar, namely Hamad General Hospital and Alkhor Hospital. The study included young patients (16–45 years old) admitted with ICH between January 1, 2015, and December 31, 2018. Results: We examined 238 consecutive young patients with ICH consisting of 212 (89.1%) males and 26 (10.9%) females. The mean age was 37.8±6.23 years. The most common risk factor found in 187 (78.6%) patients was hypertension (HTN), while 19 (8.0%) patients had no obvious risk factors (cryptogenic). The primary site of bleeding was cerebral cortex (lobar) in 107 (44.96%) patients and then basal ganglia in 97 (40.76%) patients. The in-hospital mortality was 19 (8.0%); the National Institutes of Health Stroke Scale >14 on admission (adjusted OR=2.06; 95% CI=1.448–2.938; p<0.001), Barthel index score ≤40 on admission (adjusted OR=1.09; 95% CI=1.015–1.178; p=0.019), and HTN (adjusted OR=0.075; 95% CI=0.008–0.724; p=0.025) were found to be independent predictors of in-hospital mortality by multivariate analysis. A 1-year follow-up showed mortality in 7 (3.2%) patients and no new events in 139 (63.8%) cases. Conclusion: HTN, smoking, and excessive alcohol consumption are important modifiable risk factors for ICH among young patients in Qatar, requiring early identification and treatment to prevent this dangerous type of stroke. In addition, we recommend conducting further studies focusing on the genetic risk factors of ICH among young adults, particularly those with cryptogenic ICH, to identify whether genetic risk factors are involved.