Serum arachidonic acid levels is a predictor of poor functional outcome in acute intracerebral hemorrhage

Background: Experimental animal model studies have shown neuroprotective properties of magnesium. We assessed the relationship between admission magnesium and admission stroke severity and 3-month clinical outcomes in patients with acute intracerebral hemorrhage (ICH). Methods: The present study included 323 patients with acute ICH who were prospectively identified. Demographic characteristics, lifestyle risk factors, National Institute of Health Stroke Scale (NIHSS) score, hematoma volumes, and other clinical features were recorded at baseline for all participants. Patients were divided into three groups based on the admission magnesium levels (T1: <0.84; T2: 0.84-0.91; T3: =0.91 mmol/L). Clinical outcomes were death, poor functional outcome (defined by modified rankin ccale [mRS] scores 3-6) at 3 months. Results: After 3-month follow-up, 40 (12.4%) all-cause mortality and 132 (40.9%) poor functional outcome were documented. Median NIHSS scores for each tertile (T1 to T3) were 8.0, 5.5, and 6.0, and median hematoma volumes were 10.0, 8.05, and 12.4 ml, respectively. There was no significant association between baseline NIHSS scores (P=0.176) and hematoma volumes (P=0.442) in T3 and T1 in multivariable linear regression models. Compared with the patients in T1, those in T3 were associated with less frequency of all-cause mortality [adjusted odds ratio (OR), 0.10; 95% confidence interval (CI), 0.02-0.54; P-trend=0.010] but not poor functional outcome (adjusted OR, 1.80; 95%CI, 0.71-4.56; P-trend=0.227) after adjustment for potential confounders. Conclusion: Elevated admission serum magnesium level is associated with lower odds of mortality but not poor functional outcome at 3 months in patients with acute ICH.

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Obesity is associated with better survival and functional outcome after acute intracerebral hemorrhage

Journal of the Neurological Sciences ◽

10.1016/j.jns.2016.09.029 ◽

2016 ◽

Vol 370 ◽

pp. 140-144 ◽

Cited By ~ 6

Author(s):

Weiping Sun ◽

Ying Xian ◽

Yining Huang ◽

Wei Sun ◽

Ran Liu ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Acute Intracerebral Hemorrhage

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Prediabetes is associated with poor functional outcome in patients with intracerebral hemorrhage

Brain and Behavior ◽

10.1002/brb3.1530 ◽

2020 ◽

Vol 10 (4) ◽

Author(s):

Qiongzhang Wang ◽

Guiqian Huang ◽

Fei Chen ◽

Pinglang Hu ◽

Wenwei Ren ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Poor Functional Outcome

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Abstract P440: Inpatient Blood Pressure Variability is Associated With Mortality and Poor Functional Outcome in Patients With Intracerebral Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.p440 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Evangelos Pavlos Myserlis ◽

Jessica R Abramson ◽

Haitham Alabsi ◽

Christopher D Anderson ◽

Alessandro Biffi ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Blood Pressure Variability ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Poor Functional Outcome ◽

Logistic Regression Models ◽

Established Risk Factor ◽

The Impact

Introduction: Although elevated blood pressure (BP) is an established risk factor for intracerebral hemorrhage (ICH), the impact of acute BP fluctuations on ICH outcomes remains unclear. In this study, we sought to investigate the effect of acute BP variability (BPV) on mortality and functional outcome in ICH survivors. Methods: Subjects were consecutive ICH patients ≥ 18 years with available inpatient BP data, who survived hospitalization. Four measures of systolic BPV were calculated: standard deviation (SD), coefficient of variation (CoV), average real variability (ARV), and successive variation (SV). Our outcomes were (1) death and (2) poor functional outcome, defined as a modified Rankin Score (mRS) of 3-6 in a period between 60-120 days after discharge. We assessed the effect of hyperacute (ICH event-72 hours) and acute/subacute (72 hours-discharge) BPV on outcomes. We constructed Cox proportional hazards and logistic regression models to investigate the associations of BPV (per 10 mmHg increase) with mortality and poor functional outcome, respectively, after adjustment for potential confounders. Results: We included 345 patients, 120 of whom had available mRS data. 151 (43.8%) patients were female and 280 (81.2%) were white; mean age was 71 (±13) years. SBP ARV and SBP SV were the strongest predictors of mortality (HR 2.53-2.91 per 10 mmHg increase), while SBP SD, CoV, and SV were the strongest predictors of poor functional outcome (OR 2.89-5.14 per 10 mmHg increase) (Table) . These associations remained significant when analyzing both hyperacute as well as acute/subacute BPV. Compared to hyperacute BPV, acute/subacute BPV was more strongly associated with both mortality and poor functional outcome. Conclusion: Inpatient blood pressure variability is an important determinant of mortality and poor functional outcome in ICH survivors. Further studies are needed to investigate the role of addressing BPV as a potential target for intervention.

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Abstract T MP65: Rate of Peri-Hematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage

Stroke ◽

10.1161/str.46.suppl_1.tmp65 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Sebastian Urday ◽

Lauren A Beslow ◽

David Goldstein ◽

Feng Dai ◽

Fan Zhang ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Symptom Onset ◽

Intraventricular Hemorrhage ◽

Strong Association ◽

Expansion Rate ◽

Multivariable Model ◽

Hematoma Volume ◽

Poor Functional Outcome ◽

The Relationship

Background and Purpose: There have been conflicting reports regarding the association between peri-hematomal edema (PHE) in spontaneous intracerebral hemorrhage (ICH) and outcome. We hypothesized that PHE expansion rate from baseline to 24 hours predicts mortality and poor functional outcome after ICH. Methods: ICH, PHE and intraventricular hemorrhage volumes were measured for 139 subjects who presented with primary ICH and received head computed tomography scans at baseline and 24-hours post-ICH. Subjects were retrospectively identified from a prospective cohort study of ICH. Inclusion criteria were age over 18 years with primary spontaneous supratentorial ICH. Exclusion criteria were infratentorial hemorrhage, primary intraventricular hemorrhage, or any suspected cause of secondary ICH. Logistic regression was performed to evaluate the relationship between PHE expansion rate and 90-day mortality and functional outcome. Poor functional outcome was defined as a modified Rankin Scale (mRS) score > 2. Results: There was a strong association between PHE expansion rate and mortality (OR 1.42, p = 0.0025) and a trend in the correlation between PHE expansion rate and poor outcome (OR 1.50, p = 0.07). In a multivariable model accounting for hematoma volume and time from symptom onset to 24 hour scan, PHE expansion rate was a significant predictor of mortality (OR 1.07, p = 0.032). In a multivariable model accounting for hematoma volume, age, Glasgow Coma Scale score, presence of intraventricular hemorrhage and time from symptom onset to 24 hour scan, PHE expansion rate predicted poor functional outcome (OR 2.58, p = 0.05). Conclusions: PHE expansion rate predicts outcome in ICH and may represent a novel therapeutic target.

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Abstract WP356: Eligibility Criteria in Clinical Trials on Intracerebral Hemorrhage Applied to an Unselected Cohort: The Lund Stroke Register

Stroke ◽

10.1161/str.47.suppl_1.wp356 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Björn M Hansen ◽

Natalie Ullman ◽

Bo Norrving ◽

Daniel F Hanley ◽

Arne Lindgren

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Therapeutic Benefit ◽

Inclusion Criteria ◽

Poor Functional Outcome ◽

Eligibility Criteria ◽

Survival Status ◽

Lower Baseline ◽

Unselected Cohort ◽

Stroke Register

Introduction: Strict patient selection in medical or surgical trials on intracerebral hemorrhage (ICH) is needed to optimize therapeutic benefit but limits trial enrolment as well as overall applicability of results. We studied the applicability of previous, current, and planned large interventional ICH trials by applying each trial’s defined inclusion criteria to an unselected cohort of ICH patients. Methods: Large interventional ICH trials were identified via trial registration databases. To estimate eligibility rates, each trial’s inclusion criteria were applied on an unselected consecutive group of first-ever ICH patients from the prospective hospital-based Lund Stroke Register. Subsequently, 30 day survival status was obtained from the National Census Office and 90 day poor functional outcome (modified Rankin Scale ≥4 or death) from the Swedish Stroke Register or medical files. Results: Among 253 included ICH patients, estimated eligibility rates ranged from 2-38% for the identified 11 large interventional ICH trials (Figure 1). Patients not eligible for any of the trials (N=91, 36%) had: more extensive intraventricular hemorrhage (p<0.001); lower baseline level of consciousness (p<0.001); higher rate of cerebellar ICH and lower rates of lobar ICH (p<0.001). No significant age, sex, or ICH volume differences were observed. The 30 day mortality rates among eligible patients were 0-33% depending on selected trial. The mortality rate for patients not eligible for any trial was 55% vs 19% for patients eligible in ≥1 trial (95% CI: 45-65% vs 13-25%; p<0.001). Non-eligible ICH patients more frequently had poor functional outcome (75% vs 49%; 95% CI: 65-85% vs 41-57%; p<0.001). Conclusions: There is great variation in proportions of unselected ICH patients eligible for inclusion in treatment trials. Even in trials with broad entry criteria only a minority is eligible, which need to be considered when translating ICH-trial results into clinical practice.

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Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage

Critical Care ◽

10.1186/cc8961 ◽

2010 ◽

Vol 14 (2) ◽

pp. R63 ◽

Cited By ~ 30

Author(s):

Jennifer Diedler ◽

Marek Sykora ◽

Philipp Hahn ◽

Kristin Heerlein ◽

Marion N Schölzke ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Poor Functional Outcome

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Sulfonylurea drug pretreatment and functional outcome in diabetic patients with acute intracerebral hemorrhage

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.3252 ◽

2017 ◽

Vol 381 ◽

pp. 182-187 ◽

Cited By ~ 3

Author(s):

Jason J. Chang ◽

Yasser Khorchid ◽

Ali Kerro ◽

L. Goodwin Burgess ◽

Nitin Goyal ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Diabetic Patients ◽

Acute Intracerebral Hemorrhage

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Intraventricular Extension of Supratentorial Intracerebral Hemorrhage: The Modified Graeb Scale Improves Outcome Prediction in Lund Stroke Register

Neuroepidemiology ◽

10.1159/000442575 ◽

2015 ◽

Vol 46 (1) ◽

pp. 43-50 ◽

Cited By ~ 15

Author(s):

Björn M. Hansen ◽

Timothy C. Morgan ◽

Joshua F. Betz ◽

Pia C. Sundgren ◽

Bo Norrving ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Outcome Prediction ◽

Characteristic Analysis ◽

Poor Functional Outcome ◽

Survival Status ◽

Prognostic Accuracy ◽

Unselected Population ◽

Stroke Register

Background/Aims: The modified Graeb Scale (mGS) is a semi-quantitative method to assess the extension of intraventricular hemorrhage (IVH) in patients with intracerebral hemorrhage (ICH). The mGS has been shown to prognosticate outcome after ICH in cohorts derived from convenience samples. We evaluated the external validity of mGS in supratentorial ICH-patients from an unselected cohort. Methods: ICH-patients were included prospectively and consecutively in Lund Stroke Register. Follow-up survival status was obtained from the National Census Office; functional outcome was obtained from the Swedish Stroke Register or medical records. Using multivariate analyses, we examined if mGS was related to 30-day survival or poor functional outcome (modified Rankin Scale ≥4) at 90 days. Results: Of 198 supratentorial ICH-patients, 86 (43%) had IVH (median mGS 12, range 1-28). In multivariate regression analyses, the mGS independently predicted 30-day mortality (per point; OR 1.16; 95% CI 1.06-1.27; p = 0.002) and poor functional outcome (OR 1.11; 95% CI 1.02-1.20; p = 0.011) after ICH. In receiver-operator characteristic analysis, the addition of mGS tended to be associated with a higher prognostic accuracy for survival (area under curve 0.886 vs. not including mGS 0.812; p = 0.053). Conclusions: The mGS improves outcome prediction after supratentorial ICH beyond other previously established factors in an unselected population.

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A Delayed Modified ICH Score Outperforms Baseline Scoring in Acute Intracerebral Hemorrhage

The Neurohospitalist ◽

10.1177/1941874419896715 ◽

2019 ◽

Vol 10 (3) ◽

pp. 217-220

Author(s):

Ronda Lun ◽

Vignan Yogendrakumar ◽

Dylan Blacquiere ◽

Michel Shamy ◽

Grant Stotts ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Area Under The Curve ◽

Predictive Ability ◽

Patient Characteristics ◽

Prognostic Scores ◽

Secondary Outcome ◽

Predictive Values ◽

Poor Outcome ◽

Acute Intracerebral Hemorrhage

The Modified Intracerebral Hemorrhage (MICH) score is a simple tool created to provide prognostication in basal ganglia hemorrhages. Current prognostic scores, including the MICH, are based on the assessment of baseline patient characteristics, failing to account for significant developments, such as intraventricular extension and clinical deterioration, which may occur over the first 72 hours. We propose to validate the MICH in all hemorrhage locations and hypothesize that its calculation at 72 hours will outperform its baseline counterpart with respect to predicting mortality and functional outcome. We performed a retrospective analysis of collated data from the Virtual International Stroke Trials Archive database. Primary outcome was 90-day mortality. Secondary outcome was poor outcome (modified Rankin Scale 4-6) at 90 days. Receiver operating characteristic curves were generated looking at the predictive ability of the MICH score for mortality and poor outcome, at baseline and at 72 hours. Competing curves were assessed with nonparametric methods. A total of 226 patients were included, with a 90-day mortality of 22.5%. The MICH scores calculated at 72 hours were more predictive of mortality than at baseline (area under the curve [AUC]: 0.89 [95% confidence interval [CI]: 0.83-0.94] vs 0.78 [95% CI: 0.70-0.85]), P < .01. The MICH scores at 72 hours similarly better predicted functional outcome (AUC: 0.78 [95% CI: 0.72-0.84] vs AUC: 0.72 [95% CI: 0.66-0.78]), P = .047. The MICH score has positive prognostic value for mortality and poor functional outcome in all hemorrhage locations. Delaying its calculation resulted in higher predictive values for both and suggests that delaying discussions around withdrawal of care may result in more accurate prognostication in acute intracerebral hemorrhage.

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