The impact of intracerebral hemorrhage (ICH) onset time (night vs. day) on in-hospital mortality, in-hospital complications, and early functional outcomes remains inconclusive. This study aimed to explore the associations between night and day ICH onset and these critical endpoints. Using data extracted from the China Stroke Center Alliance, this cohort study included 81,913 patients within 24 h of ICH onset. Multivariable logistic regressions assessed the associations between ICH onset time and in-hospital mortality, hematoma expansion, early poor neurological outcomes, and in-hospital complications. The onset times of ICH showed a major peak between 08:00 and 11:00 and a minor peak between 15:00 and 18:00. Compared to patients with night-onset ICH (18:00-06:00), those with day-onset ICH (06:00-18:00) had lower risks of in-hospital mortality (adjusted odds ratio aOR = 0.87; 95% confidence interval CI, 0.78 to 0.96, P = 0.01), early poor neurological outcomes (aOR = 0.93; 95% CI 0.90 to 0.97, P < 0.01), and stroke-associated infections (aOR = 0.93; 95% CI 0.90 to 0.97, P < 0.01). The natural indirect effects of night-onset ICH on in-hospital mortality via admission National Institutes of Health Stroke Scale and baseline Glasgow Coma Scale scores were highly significant (aOR = 1.07 and 1.08, respectively; both P < 0.0001). Patients with ICH occurring between 22:00 and 02:00 who did not undergo hematoma evacuation were more likely to experience in-hospital mortality (aOR = 1.12; 95% CI 1.04 to 1.21, P < 0.001) and early poor neurological outcomes (aOR = 1.09; 95% CI 1.01 to 1.19, P = 0.03). However, night-onset did not significantly affect in-hospital mortality for patients with ICH undergoing hematoma evacuation. Night-onset ICH was associated with more severe strokes and higher risks of in-hospital mortality, stroke-associated infections, and early poor neurological outcomes. However, undergoing hematoma evacuation may mitigate the detrimental effect of night-onset ICH on in-hospital mortality.
Wei et al. (Sun,) studied this question.