Extreme temperature increases the severity of intracerebral hemorrhage: An analysis based on the cold region of China

Abstract

Objective: The purpose of this study was to find a suitable model to evaluate the relationship between temperature and intracerebral hemorrhage (ICH) and explore the effects of cold spells and heat waves on the clinicopathological parameters of ICH patients. Methods: We conducted a retrospective study based on the ICH admission in the First Affiliated Hospital of Harbin Medical University from 2015 to 2020 (N = 11 124). The relationship between different seasons and the number of patients with ICH was explored. Poisson Akaike information criterion (AIC) was used to select the optimal model for temperature and ICH. Binary logistic regression analysis was used to investigate the association between extreme temperatures and clinicopathological features. Results: Hospital admissions for patients with ICH showed monthly changes. The optimal cold spell was defined as the daily average temperature < 3rd percentile, lasting for five days, while the optimal heat wave was defined as the daily average temperature >97th percentile, lasting for three days. Based on the generalized extreme weather model, cold climate significantly increased the risk of hematoma volume expansion (OR 1.003; 95% CI: 1.000-1.005, P = 0.047). In the optimal model, the occurrence of cold spells and heat waves increased the risk of midline shift in both conditions (OR 1.067; 95% CI: 1.021-1.115, P = 0.004; OR 1.077; 95% CI: 1.030-1.127, P = 0.001). Conclusion: Our study shows that seasonal cold spells and heat waves are essential factors affecting ICH severity, and targeted preventive measures should be taken to minimize the pathological impacts.

Keywords

ambient temperature / intracerebral hemorrhage / hematoma volume / midline shift

References

[[1]] GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020; 396(10258): 1204-1222.

[[2]] Wang W Z, Jiang B, Sun H X, et al. Prevalence, incidence, and mortality of stroke in China: results from a Nationwide Population-based survey of 480 687 adults. Circulation, 2017; 135(8): 759-771.

[[3]] Ma Q, Li R, Wang L J, P., et al. Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health, 2021; 6(12): e897-e906.

[[4]] GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol, 2021; 20(10): 795-820.

[[5]] Fang C W, Ma M C, Lin H J, et al. Ambient temperature and spontaneous intracerebral haemorrhage: a cross-sectional analysis in Tainan, Taiwan. BMJ Open, 2012; 2(3):e000842.

[[6]] Gomes J, Damasceno A, Carrilho V, et al. Triggering of stroke by ambient temperature variation: a case-crossover study in Maputo, Mozambique. Clin Neurol Neurosurg, 2015; 129: 72-77.

[[7]] Polcaro-Pichet S, Kosatsky B J, Potter M, et al. Bilodeau-Bertrand, and N. Auger, Effects of cold temperature and snowfall on stroke mortality: A case-crossover analysis. Environ Int, 2019; 126: 89-95.

[[8]] Li T, Horton R M, Bader D A, et al. Long-term projections of temperature-related mortality risks for ischemic stroke, hemorrhagic stroke, and acute ischemic heart disease under changing climate in Beijing, China. Environ Int, 2018; 112: 1-9.

[[9]] Zheng D H, Arima E, Heeley A, et al. Ambient temperature and severity of intracerebral haemorrhage: the INTERACT1 study. Neuroepidemiology, 2014; 42(3): 169-173.

[[10]] Wang W D, Wang H, Liu H, et al. Rend of declining stroke mortality in China: reasons and analysis. Stroke Vasc Neurol, 2017; 2(3): 132-139.

[[11]] Guo Y A, Gasparrini B G, Armstrong B, et al. Heat wave and mortality: a multicountry, multicommunity study. Environ Health Perspect, 2017; 125(8): 087006.

[[12]] Gao J F, Yu Z, Xu J, et al. The association between cold spells and admissions of ischemic stroke in Hefei, China: modified by gender and age. Sci Total Environ, 2019; 669: 140-147.

[[13]] Monteiro A V, Carvalho J, Góis C, et al. Use of "Cold Spell" indices to quantify excess Chronic Obstructive Pulmonary Disease (COPD) morbidity during winter (November to March 2000-2007): case study in Porto. Int J Biometeorol, 2013; 57(6): 857-870.

[[14]] Qi X Z, Wang X, Xia J, et al. The effects of heatwaves and cold spells on patients admitted with acute ischemic stroke. Ann Transl Med, 2021; 9(4): 309.

[[15]] Ponjoan A J, Blanch L, Alves-Cabratosa R, et al. Effects of extreme temperatures on cardiovascular emergency hospitalizations in a Mediterranean region: a self-controlled case series study. Environ Health, 2017; 16(1): 32.

[[16]] Song X S, Wang, Hu Y L, et al. Impact of ambient temperature on morbidity and mortality: an overview of reviews. Sci Total Environ, 2017; 586: 241-254.

[[17]] Han J S, Liu J, Zhang L et al. The impact of temperature extremes on mortality: a time-series study in Jinan, China. BMJ Open, 2017; 7(4): e014741.

[[18]] Yamamoto S M, Koh K, Matsumura K, et al. Impact of low ambient temperature on the occurrence of spontaneous intracerebral hemorrhage-analysis of population-based stroke registry in Toyama, Japan. J Stroke Cerebrovasc Dis, 2022; 31(1): 106156.

[[19]] Luo Y H, Li F, Huang N, et al. The cold effect of ambient temperature on ischemic and hemorrhagic stroke hospital admissions: a large database study in Beijing, China between years 2013 and 2014-utilizing a distributed lag non-linear analysis. Environ Pollut, 2018; 232: 90-96.

[[20]] Chen J H, Jiang L, Wu X, et al. Association of ischemic and hemorrhagic strokes hospital admission with extreme temperature in Nanchang, China-a case-crossover study. J Clin Neurosci, 2017; 43: 89-93.

[[21]] Wang Q C, Gao H, Liu W, et al. Hypertension modifies the shortterm effects of temperature on morbidity of hemorrhagic stroke. Sci Total Environ, 2017; 598: 198-203.

[[22]] Guo P M, Zheng Y, Wang W, et al. Effects of ambient temperature on stroke hospital admissions: Results from a time-series analysis of 104,432 strokes in Guangzhou, China. Sci Total Environ, 2017; 580: 307- 315.

[[23]] Cuspidi C, Ochoa J E, Parati G. Seasonal variations in blood pressure: a complex phenomenon. J Hypertens, 2012; 30(7): 1315-1320.

[[24]] McArthur K, Dawson J, Walters D, What is it with the weather and stroke? Expert Rev Neurother, 2010; 10(2): 243-249.

[[25]] Valeri C R, MacGregor H, Cassidy G, et al. Effects of temperature on bleeding time and clotting time in normal male and female volunteers. Crit Care Med, 1995; 23(4): 698-704.

[[26]] Takumi I, Mishina M, Kominami S, et al. Ambient temperature change increases in stroke onset: analyses based on the Japanese regional metrological measurements. J Nippon Med Sch, 2015; 82(6): 281-286.

[[27]] Wang X Y, Cao D, Hong D, et al. Ambient temperature and stroke occurrence: a systematic review and meta-analysis. Int J Environ Res Public Health, 2016; 13(7): 698.

[[28]] Li L, Huang S L, Duan Y R, et al. Effect of ambient temperature on stroke onset: a time-series analysis between 2003 and 2014 in Shenzhen, China. Occup Environ Med, 2021. Epub ahead of print.

[[29]] Shah A S, Lee K K, McAllister D A, et al. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ, 2015; 350: h1295.

[[30]] Xu Z, Tong S, Pan H, et al. Associations of extreme temperatures with hospitalizations and post-discharge deaths for stroke: what is the role of pre-existing hyperlipidemia? Environ Res, 2021; 193: 110391.