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Cerebral small vessel disease markers and long-term prognosis in spontaneous intracerebral hemorrhage: the HAGAKURE-ICH study

Hypertension Research volume 48, pages 233–243 (2025)Cite this article

A Comment to this article was published on 14 February 2025

Abstract

We investigated the effects of individual and cumulative cerebral small vessel disease (SVD) markers on long-term clinical outcomes in spontaneous intracerebral hemorrhage (sICH) patients. This prospective, single-center cohort study was conducted from 2012 to 2019. SVD markers, including lacunae, cerebral microbleeds, white matter hyperintensity (WMH), and perivascular spaces in the basal ganglia, were assessed to calculate a summary SVD score. Patients were categorized into severe (score ≥3) and non-severe (score 0–2) SVD burden groups. Functional prognosis was defined as recovery, no change, or decline based on modified Rankin Scale changes at 2 years after discharge, excluding death. Associations of SVD burden and individual SVD markers with outcomes were evaluated using Cox proportional hazards modeling for recurrent stroke and all-cause mortality, and using ordinal logistic regression for functional prognosis. Among 155 sICH patients who underwent MRI, 98 showed severe SVD burden. Recurrent stroke and all-cause mortality rates were 2.2 and 8.3 per 100 patient-years, respectively, over a median 2.1-year follow-up. In terms of functional prognosis, 57 patients (51.8%) recovered, 32 (29.1%) showed no change, and 21 (19.1%) declined. A significant association was apparent between severe SVD burden and poorer functional prognosis (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.04–6.04; p = 0.042), particularly with moderate-to-severe WMH (OR 2.54, 95%CI 1.02–6.54; p = 0.048). The cumulative effects of SVD markers inhibited long-term functional recovery in sICH patients. Severe SVD burden, as well as moderate-to-severe WMH, can be indicators of long-term prognosis after sICH.

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Data availability

Analyses for the HAGAKURE study are on-going; however, once completed, the data generated from this work will be available upon reasonable request.

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Acknowledgements

We are indebted to Dr. Kiku Uwatoko, Dr. Hirome Minagawa, Kazuhiro Kawamoto, Yoko Wakabayashi, and Miki Fujii for data management.

Funding

The HAGAKURE was organized by a central coordinating center located at Saga University Hospital and an associated center at Kansai Medical University, with funding support by a Grant-in-Aid for Scientific Research (C), JSPS KAKENHI (grant nos. 15K10364 and 21K10510).

Author information

Authors and Affiliations

  1. Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan

    Shuhei Ikeda, Yusuke Yakushiji, Jun Tanaka, Makoto Eriguchi, Masafumi Kosugi, Kohei Suzuyama, Megumi Mizoguchi, Chika Shichijo, Toshihiro Ide, Yukiko Nagaishi, Natsuki Ono, Masaaki Yoshikawa, Yoshiko Katsuki, Haruki Koike & Hideo Hara

  2. Department of Neurology, Kansai Medical University, Hirakata, Japan

    Shuhei Ikeda, Yusuke Yakushiji & Shohei Ono

  3. Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan

    Masashi Nishihara & Hiroyuki Irie

  4. Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan

    Atsushi Ogata & Tatsuya Abe

Authors
  1. Shuhei Ikeda
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  2. Yusuke Yakushiji
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  8. Masafumi Kosugi
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Contributions

Study conception: SI, YY, JT, and HH. Data acquisition: SI, YY, JT, ME, SO, MK, KS, MM, CS, TI, YN, NO, MY, and YK. Analysis and interpretation of data: SI, YY, JT, MN, and AO. Drafting the manuscript: SI, YY, and HH. Supervision of the study: YY, HI, TA, HK, and HH.

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Correspondence to Yusuke Yakushiji.

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Ikeda, S., Yakushiji, Y., Tanaka, J. et al. Cerebral small vessel disease markers and long-term prognosis in spontaneous intracerebral hemorrhage: the HAGAKURE-ICH study. Hypertens Res 48, 233–243 (2025). https://doi.org/10.1038/s41440-024-01906-1

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