Obesity is associated with better survival and functional outcome after 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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Serum arachidonic acid levels is a predictor of poor functional outcome in acute intracerebral hemorrhage

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2021.09.012 ◽

2021 ◽

Author(s):

Junichiro Takahashi ◽

Kenichiro Sakai ◽

Takeo Sato ◽

Hiroki Takatsu ◽

Teppei Komatsu ◽

...

Keyword(s):

Arachidonic Acid ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Poor Functional Outcome ◽

Acute Intracerebral Hemorrhage

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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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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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Imaging-Based Outcome Prediction of Acute Intracerebral Hemorrhage

Translational Stroke Research ◽

10.1007/s12975-021-00891-8 ◽

2021 ◽

Author(s):

Jawed Nawabi ◽

Helge Kniep ◽

Sarah Elsayed ◽

Constanze Friedrich ◽

Peter Sporns ◽

...

Keyword(s):

Machine Learning ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Image Features ◽

Ct Scans ◽

Youden Index ◽

Survival Prediction ◽

Enhanced Ct ◽

Acute Intracerebral Hemorrhage ◽

Ich Score

AbstractWe hypothesized that imaging-only-based machine learning algorithms can analyze non-enhanced CT scans of patients with acute intracerebral hemorrhage (ICH). This retrospective multicenter cohort study analyzed 520 non-enhanced CT scans and clinical data of patients with acute spontaneous ICH. Clinical outcome at hospital discharge was dichotomized into good outcome and poor outcome using different modified Rankin Scale (mRS) cut-off values. Predictive performance of a random forest machine learning approach based on filter- and texture-derived high-end image features was evaluated for differentiation of functional outcome at mRS 2, 3, and 4. Prediction of survival (mRS ≤ 5) was compared to results of the ICH Score. All models were tuned, validated, and tested in a nested 5-fold cross-validation approach. Receiver-operating-characteristic area under the curve (ROC AUC) of the machine learning classifier using image features only was 0.80 (95% CI [0.77; 0.82]) for predicting mRS ≤ 2, 0.80 (95% CI [0.78; 0.81]) for mRS ≤ 3, and 0.79 (95% CI [0.77; 0.80]) for mRS ≤ 4. Trained on survival prediction (mRS ≤ 5), the classifier reached an AUC of 0.80 (95% CI [0.78; 0.82]) which was equivalent to results of the ICH Score. If combined, the integrated model showed a significantly higher AUC of 0.84 (95% CI [0.83; 0.86], P value <0.05). Accordingly, sensitivities were significantly higher at Youden Index maximum cut-offs (77% vs. 74% sensitivity at 76% specificity, P value <0.05). Machine learning–based evaluation of quantitative high-end image features provided the same discriminatory power in predicting functional outcome as multidimensional clinical scoring systems. The integration of conventional scores and image features had synergistic effects with a statistically significant increase in AUC.

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Abstract 32: Optimal Threshold for Defining Early Clinical Deterioration as a Predictor of Poor Outcome in Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.45.suppl_1.32 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nerses Sanossian ◽

May A Kim-Tenser ◽

David S Liebeskind ◽

Adrian M Burgos ◽

Scott Hamilton ◽

...

Keyword(s):

Glasgow Coma Scale ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Final Outcome ◽

Clinical Deterioration ◽

Coma Scale ◽

Poor Outcome ◽

Scale Scores ◽

Acute Intracerebral Hemorrhage ◽

Gcs Score

Background: Many patients with acute intracerebral hemorrhage (ICH) clinically deteriorate between the time of paramedic assessment in the field and Emergency Department (ED) arrival. Cohort studies have used decline in the Glasgow Coma Scale (GCS) score from prehospital assessment to ED assessment to identify patients with early clinical deterioration (ECD), but the degree of GCS decline that best correlates with poor final functional outcome has not been delineated. Methods: Consecutive cases with primary ICH on initial imaging were identified from the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 clinical trial of intravenous magnesium vs. placebo. All subjects underwent GCS evaluation in the field by paramedics within 2 hours from symptom onset, and again in the ED by study research coordinators. Poor outcome was defined as a modified Rankin Scale of 4 to 6 at 3-months. Deteriorations in GCS from one point through 10 points were evaluated in relation to poor final functional outcome through receiver operating characteristic (ROC) and area under curve (AUC). Results: Among the 369 (22%) patients with primary ICH, mean [SD] age was 65 [13] years, 34% were women, 79% White race, 34% Hispanic ethnicity, 80% had pre-existing hypertension, 20% diabetes, 18% smokers. Paramedic on scene time was a median [IQR] of 23 [15-40] minutes from last known well and time of GCS assessment in the ED was a median of 140 [119-175] minutes after last known well. Glasgow Coma Scale scores were mean 14.4 (SD 1.5) and median 15 [15-15] in the field and mean 12.1 (SD 4.5) and median 15 [10-15] in the ED, and 59% had a poor outcome at 3 months. Frequency of deteriorations on the GCS included: ≥1 point - 38%, ≥2points - 31%, ≥3 points - 27%, ≥5 points - 21%, and ≥10 points - 13%. The best performing cutpoints on the the ROC for predicting poor final outcome were ECD definitions of GCS decline of >=1: sensitivity 54% and specificity 85%; and GCS decline of >=2: sensitivity 46% and specificity 91%. The c statistic for ECD defined as a 1 point GCS decline as a predictor of poor final outcome was 0.71 (95%CI 0.66, 0.76). Conclusions: Early clinical deterioration of GCS is common and its presence may be helpful in predicting poor outcome.

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Impact of serum omentin-1 concentrations on functional outcome among acute intracerebral hemorrhage patients

Clinica Chimica Acta ◽

10.1016/j.cca.2020.01.026 ◽

2020 ◽

Vol 503 ◽

pp. 169-174

Author(s):

Guo-Hai Zhang ◽

Zhe-Hao Ye ◽

Hao-Jie Guan ◽

Mi Guo ◽

Xin-Xiang Zhou ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Acute Intracerebral Hemorrhage

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J-shape relation of blood pressure reduction and outcome in acute intracerebral hemorrhage: A pooled analysis of INTERACT2 and ATACH-II individual participant data

International Journal of Stroke ◽

10.1177/17474930211064076 ◽

2022 ◽

pp. 174749302110640

Author(s):

Xia Wang ◽

Gian Luca Di Tanna ◽

Tom J Moullaali ◽

Renee’ H Martin ◽

Virginia B Shipes ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Cerebral Hemorrhage ◽

Blood Pressure Reduction ◽

Random Effect ◽

Pooled Analysis ◽

Moderate Degree ◽

Pressure Reduction ◽

Acute Intracerebral Hemorrhage

Objective: The aim of this study was to better define the shape of association between the degree (“magnitude”) of early (< 1 h) reduction in systolic blood pressure (SBP) and outcomes in patients with acute intracerebral hemorrhage (ICH) through pooled analysis of the second Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) and second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) datasets. Methods: Association of the continuous magnitude of SBP reduction described using cubic splines and an ordinal measure of the functional outcome on the modified Rankin scale (mRS) scores at 90 days were analyzed in generalized linear mixed models. Models were adjusted for achieved (mean) and variability (standard deviation, SD) of SBP between 1 and 24 h, various baseline covariates, and trial as a random effect. Results: Among 3796 patients (mean age 63.1 (SD = 13.0) years; female 37.4%), with a mean magnitude (< 1 h) of SBP reduction of 28.5 (22.8) mmHg, those with larger magnitude were more often non-Asian and female, had higher baseline SBP, received multiple blood pressure (BP) lowering agents, and achieved lower SBP levels in 1–24 h. Compared to those patients with no SBP reduction within 1 h (reference), the adjusted odds of unfavorable functional outcome, according to a shift in mRS scores, were lower for SBP reductions up to 60 mmHg with an inflection point between 32 and 46 mmHg, but significantly higher for SBP reductions > 70 mmHg. Similar J-shape associations were evident across various time epochs across 24 h and consistent according to baseline hematoma volume and SBP and history of hypertension. Interpretation: A moderate degree of rapid SBP lowering is associated with improved functional outcome after ICH, but large SBP reductions over 1 h (e.g. from > 200 to target < 140 mmHg) were associated with reduction, or reversal, of any such benefit.

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