Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage

Background: In spontaneous intracerebral hemorrhage (ICH), black hole sign has been proposed as a promising imaging marker that predicts hematoma expansion in patients with ICH. The aim of our study was to investigate whether admission CT black hole sign predicts hematoma growth in patients with ICH. Methods: From July 2011 till February 2016, patients with spontaneous ICH who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. The presence of black hole sign on admission non-enhanced CT was independently assessed by 2 readers. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Univariate and multivariable logistic regression analyses were performed to assess the association between the presence of the black hole sign and functional outcome. Results: A total of 225 patients (67.6% male, mean age 60.3 years) were included in our study. Black hole sign was identified in 32 of 225 (14.2%) patients on admission CT scan. The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, baseline ICH volume, admission Glasgow Coma Scale score, and presence of black hole sign on baseline CT independently predict poor functional outcome at 90 days. There are significantly more patients with a poor functional outcome (defined as mRS ≥4) among patients with black hole sign than those without (84.4 vs. 32.1%, p < 0.001; OR 8.19, p = 0.001). Conclusions: The CT black hole sign independently predicts poor outcome in patients with ICH. Early identification of black hole sign is useful in prognostic stratification and may serve as a potential therapeutic target for anti-expansion clinical trials.

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Satellite Sign: A Poor Outcome Predictor in Intracerebral Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000477179 ◽

2017 ◽

Vol 44 (3-4) ◽

pp. 105-112 ◽

Cited By ~ 25

Author(s):

Yoshiteru Shimoda ◽

Satoru Ohtomo ◽

Hiroaki Arai ◽

Ken Okada ◽

Teiji Tominaga

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Multivariate Logistic Regression Analysis ◽

High Density ◽

Multivariate Logistic Regression ◽

Poor Functional Outcome ◽

Poor Outcome ◽

Intraventricular Bleeding

Background: The presence of high-density starry dots around the intracerebral hemorrhage (ICH), which we termed as a satellite sign, is occasionally observed in CT. The relationship between ICH with a satellite sign and its functional outcome has not been identified. This study aimed to determine whether the presence of a satellite sign could be an independent prognostic factor for patients with ICH. Methods: Patients with acute spontaneous ICH were retrospectively identified and their initial CT scans were reviewed. A satellite sign was defined as scattered high-density lesions completely separate from the main hemorrhage in at least the single axial slice. Functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge. Poor functional outcome was defined as mRS scores of 3-6. Univariate and multivariate logistic regression analyses were applied to assess the presence of a satellite sign and its association with poor functional outcome. Results: A total of 241 patients with ICH were enrolled in the study. Of these, 98 (40.7%) had a satellite sign. Patients with a satellite sign had a significantly higher rate of poor functional outcome (95.9%) than those without a satellite sign (55.9%, p < 0.0001). Multivariate logistic regression analysis revealed that higher age (OR 1.06; 95% CI 1.03-1.10; p = 0.00016), large hemorrhage size (OR 1.06; 95% CI 1.03-1.11; p = 0.00015), and ICH with a satellite sign (OR 13.5; 95% CI 4.42-53.4; p < 0.0001) were significantly related to poor outcome. A satellite sign was significantly related with higher systolic blood pressure (p = 0.0014), higher diastolic blood pressure (p = 0.0117), shorter activated partial thromboplastin time (p = 0.0427), higher rate of intraventricular bleeding (p < 0.0001), and larger main hemorrhage (p < 0.0001). Conclusions: The presence of a satellite sign in the initial CT scan is associated with a significantly worse functional outcome in ICH patients.

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Association Between Neck Circumference and Poor Outcome in Spontaneous Intracerebral Hemorrhage Patients: A Prospective Observational Study.

10.21203/rs.3.rs-38306/v1 ◽

2020 ◽

Author(s):

Yujian Li ◽

Huiqing Zhou ◽

Xiang Yang ◽

Jun Zheng ◽

Fan Zhang ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Prospective Observational Study ◽

Independent Predictor ◽

Multivariate Logistic Regression Analysis ◽

Neck Circumference ◽

Roc Curve Analysis ◽

Poor Functional Outcome ◽

Poor Outcome

Abstract Background: Obesity is one of the major risk factors of intracerebral hemorrhage (ICH). Neck circumference (NC) is an indicator of obesity, and little is known about the role of NC in patients with ICH. This study aimed to assess the association between NC and functional outcome in ICH patients.Methods: We prospectively analyzed data of ICH patients who received treatment at our institution from January 2018 to November 2019. Patients were categorized as two groups according to 180-day Modified Rankin Scale (MRS) score. Univariate and multivariate analyses were performed to assess whether NC was associated with poor outcome in ICH patients. Receiver operating characteristic (ROC) curve analysis was performed to manifest the significance of NC in predicting the functional outcome of ICH patients.Results: A total of 312 patients were enrolled in our study. Multivariate logistic regression analysis indicated that NC was an independent predictor of 180-day poor functional outcome (odds ratio [OR] = 1.205, 95% confidence interval [CI]: 1.075-1.350, p = 0.001). ROC analysis revealed that NC could predict poor functional outcome at 6 months.Conclusion: NC is an independent predictor of unfavorable functional outcome at 6 months in ICH patients.

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Hematoma Ventricle Distance on Computed Tomography Predicts Poor Outcome in Intracerebral Hemorrhage

Frontiers in Neuroscience ◽

10.3389/fnins.2020.589050 ◽

2020 ◽

Vol 14 ◽

Author(s):

Lan Deng ◽

Yun-Dong Zhang ◽

Jian-Wen Ji ◽

Wen-Song Yang ◽

Xiao Wei ◽

...

Keyword(s):

Computed Tomography ◽

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Final Analysis ◽

Hematoma Expansion ◽

Youden Index ◽

Multivariable Logistic Regression Analysis ◽

Poor Outcome

ObjectiveTo investigate the relationship between hematoma ventricle distance (HVD) and clinical outcome in patients with intracerebral hemorrhage (ICH).MethodsWe prospectively enrolled consecutive patients with ICH in a tertiary academic hospital between July 2011 and April 2018. We retrospectively reviewed images for all patients receiving a computed tomography (CT) within 6 h after onset of symptoms and at least one follow-up CT scan within 36 h. The minimum distance of hematoma border to nearest ventricle was measured as HVD. Youden index was used to evaluate the cutoff of HVD predicting functional outcome. Logistic regression model was used to assess the HVD data and clinical poor outcome (modified Rankin Scale 4–6) at 90 days.ResultsA total of 325 patients were included in our final analysis. The median HVD was 2.4 mm (interquartile range, 0–5.7 mm), and 119 (36.6%) patients had poor functional outcome at 3 months. After adjusting for age, admission Glasgow coma scale, intraventricular hemorrhage, baseline ICH volume, admission systolic blood pressure, blood glucose, hematoma expansion, withdrawal of care, and hypertension, HVD ≤ 2.5 mm was associated with increased odds of clinical poor outcome [odd ratio, 3.59, (95%CI = 1.72–7.50); p = 0.001] in multivariable logistic regression analysis.ConclusionHematoma ventricle distance allows physicians to quickly select and stratify patients in clinical trials and thereby serve as a novel and useful addition to predict ICH prognosis.

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Neck Circumference Is Associated With Poor Outcome in Patients With Spontaneous Intracerebral Hemorrhage

Frontiers in Neurology ◽

10.3389/fneur.2020.622476 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yujian Li ◽

Huiqing Zhou ◽

Xiang Yang ◽

Jun Zheng ◽

Fan Zhang ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Roc Analysis ◽

Operating Characteristic ◽

Independent Predictor ◽

Multivariate Logistic Regression Analysis ◽

Neck Circumference ◽

Roc Curve Analysis ◽

Poor Functional Outcome ◽

Poor Outcome

Objective: This study aimed to assess the association between neck circumference (NC) and functional outcome in intracerebral hemorrhage (ICH) patients.Methods: We prospectively analyzed data from ICH patients who received treatment at our institution from January 2018 to November 2019. Patients were categorized into two groups according to 180-day modified Rankin scale (MRS) scores. Univariate and multivariate analyses were performed to assess whether NC was associated with poor outcome in ICH patients. Receiver operating characteristic (ROC) curve analysis was performed to determine the significance of NC in predicting the functional outcome of ICH patients.Results: A total of 312 patients were enrolled in our study. Multivariate logistic regression analysis indicated that NC was an independent predictor of poor 180-day functional outcome [odds ratio (OR) = 1.205, 95% confidence interval (CI): 1.075–1.350, p = 0.001]. ROC analysis revealed that NC could predict poor functional outcome at 6 months.Conclusions: NC is an independent predictor of unfavorable functional outcome at 6 months in ICH patients.

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Timing of clinical grade assessment and poor outcome in patients with aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2012.3.jns11706 ◽

2012 ◽

Vol 117 (1) ◽

pp. 15-19 ◽

Cited By ~ 27

Author(s):

Elias A. Giraldo ◽

Jay N. Mandrekar ◽

Mark N. Rubin ◽

Stefan A. Dupont ◽

Yi Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Subarachnoid Hemorrhage ◽

Cerebral Infarction ◽

Functional Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Intracerebral Hematoma ◽

Poor Functional Outcome ◽

Poor Outcome ◽

Grade Assessment ◽

Clinical Grading

Object Timing of clinical grading has not been fully studied in patients with aneurysmal subarachnoid hemorrhage (SAH). The primary objective of this study was to identify at which time point clinical assessment using the World Federation of Neurosurgical Societies (WFNS) grading scale and the Glasgow Coma Scale (GCS) is most predictive of poor functional outcome. Methods This study is a retrospective cohort study on the association between poor outcome and clinical grading determined at presentation, nadir, and postresuscitation. Poor functional outcome was defined as a Glasgow Outcome Scale score of 1–3 at 6 months after SAH. Results The authors identified 186 consecutive patients admitted to a teaching hospital between January 2002 and June 2008. The patients' mean age (± SD) was 56.9 ± 13.7 years, and 63% were women. Twenty-four percent had poor functional outcome (the mortality rate was 17%). On univariable logistic regression analyses, GCS score determined at presentation (OR 0.80, p < 0.0001), nadir (OR 0.73, p < 0.0001), and postresuscitation (OR 0.53, p < 0.0001); modified Fisher scale (OR 2.21, p = 0.0013); WFNS grade assessed at presentation (OR 1.92, p < 0.0001), nadir (OR 3.51, < 0.0001), and postresuscitation (OR 3.91, p < 0.0001); intracerebral hematoma on initial CT (OR 4.55, p < 0.0002); acute hydrocephalus (OR 2.29, p = 0.0375); and cerebral infarction (OR 4.84, p < 0.0001) were associated with poor outcome. On multivariable logistic regression analysis, only cerebral infarction (OR 5.80, p = 0.0013) and WFNS grade postresuscitation (OR 3.43, p < 0.0001) were associated with poor outcome. Receiver operating characteristic/area under the curve (AUC) analysis demonstrated that WFNS grade determined postresuscitation had a stronger association with poor outcome (AUC 0.90) than WFNS grade assessed upon admission or at nadir. Conclusions Timing of WFNS grade assessment affects its prognostic value. Outcome after aneurysmal SAH is best predicted by assessing WFNS grade after neurological resuscitation.

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Irregular Shape as An Independent Predictor of Prognosis in Patients with Primary Intracerebral Hemorrhage

10.21203/rs.3.rs-967170/v1 ◽

2021 ◽

Author(s):

Chunyang Liu ◽

Haopeng Zhang ◽

Lixiang Wang ◽

Qiuyi Jiang ◽

Enzhou Lu ◽

...

Keyword(s):

Computed Tomography ◽

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Functional Outcomes ◽

Irregular Shape ◽

Spontaneous Intracerebral Hemorrhage ◽

Poor Outcome ◽

Irregular Shapes ◽

D Dimer

Abstract BACKGROUND AND PURPOSE The utility of non-contrast computed tomography (NCCT) markers in the prognosis of spontaneous intracerebral hemorrhage (ICH) has been concerned. This study aimed to investigate the predictive value of the computed tomography irregularity shape for poor functional outcomes in patients with spontaneous intracerebral hemorrhage. PATIENTS AND Methods: We retrospectively reviewed all 782 patients with intracranial hemorrhage in our stroke emergency center from January 2018 to September 2019. Laboratory examination and CT examination were measured within 24 hours of admission. After three months, the patient's functional outcome was assessed using the modified Rankin Scale (mRS). Multinomial logistic regression analyses were applied to identify independent predictors of functional outcome in patients with intracerebral hemorrhage. RESULTS Out of the 627 patients included in this study, those with irregular shapes on CT imaging had a higher proportion of poor outcome and mortality 90 days after discharge (P<0.001). Irregular shapes were found to be significant independent predictors of poor outcome and mortality on multiple logistic regression analysis. Besides, the increase of plasma D-dimer was associated with the occurrence of irregular shape (P=0.0387). CONCLUSIONS Patients with irregular shape showed worse functional outcomes after intracerebral hemorrhage. The elevated expression level of plasma D-dimer may be directly related to the formation of irregular shapes.

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Early Predictors of the Increase in Perihematomal Edema Volume After Intracerebral Hemorrhage: A Retrospective Analysis From the Risa-MIS-ICH Study

Frontiers in Neurology ◽

10.3389/fneur.2021.700166 ◽

2021 ◽

Vol 12 ◽

Author(s):

Gengzhao Ye ◽

Shuna Huang ◽

Renlong Chen ◽

Yan Zheng ◽

Wei Huang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Black Hole ◽

Intracerebral Hemorrhage ◽

Clinical Laboratory ◽

Characteristic Curve ◽

Hematoma Expansion ◽

Hematoma Volume ◽

Absolute Increase ◽

Poor Outcome ◽

Perihematomal Edema

Background and Purpose: Perihematomal edema (PHE) is associated with poor functional outcomes after intracerebral hemorrhage (ICH). Early identification of risk factors associated with PHE growth may allow for targeted therapeutic interventions.Methods: We used data contained in the risk stratification and minimally invasive surgery in acute intracerebral hemorrhage (Risa-MIS-ICH) patients: a prospective multicenter cohort study. Patients' clinical, laboratory, and radiological data within 24 h of admission were obtained from their medical records. The absolute increase in PHE volume from baseline to day 3 was defined as iPHE volume. Poor outcome was defined as modified Rankin Scale (mRS) of 4 to 6 at 90 days. Binary logistic regression was used to assess the relationship between iPHE volume and poor outcome. The receiver operating characteristic curve was used to find the best cutoff. Linear regression was used to identify variables associated with iPHE volume (ClinicalTrials.gov Identifier: NCT03862729).Results: One hundred ninety-seven patients were included in this study. iPHE volume was significantly associated with poor outcome [P = 0.003, odds ratio (OR) 1.049, 95% confidence interval (CI) 1.016–1.082] after adjustment for hematoma volume. The best cutoff point of iPHE volume was 7.98 mL with a specificity of 71.4% and a sensitivity of 47.5%. Diabetes mellitus (P = 0.043, β = 7.66 95% CI 0.26–15.07), black hole sign (P = 0.002, β = 18.93 95% CI 6.84–31.02), and initial ICH volume (P = 0.018, β = 0.20 95% CI 0.03–0.37) were significantly associated with iPHE volume. After adjusting for hematoma expansion, the black hole sign could still independently predict the increase of PHE (P < 0.001, β = 21.62 95% CI 10.10–33.15).Conclusions: An increase of PHE volume >7.98 mL from baseline to day 3 may lead to poor outcome. Patients with diabetes mellitus, black hole sign, and large initial hematoma volume result in more PHE growth, which should garner attention in the treatment.

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Different Effects of Hematoma Expansion on Short-Term Functional Outcome in Basal Ganglia and Thalamic Hemorrhages

BioMed Research International ◽

10.1155/2021/9233559 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Lijing Deng ◽

Kai Chen ◽

Liu Yang ◽

Zhaoxu Deng ◽

Haijun Zheng

Keyword(s):

Basal Ganglia ◽

Functional Outcome ◽

Hematoma Expansion ◽

Short Term ◽

Poor Functional Outcome ◽

Predictive Values ◽

Relative Growth ◽

Poor Outcome ◽

Absolute Growth ◽

The Impact

Purpose. To investigate the impact of hematoma expansion (HE) on short-term functional outcome of patients with thalamic and basal ganglia intracerebral hemorrhage. Methods. Data of 420 patients with deep intracerebral hemorrhage (ICH) that received a baseline CT scan within 6 hours from symptom onset and a follow-up CT scan within 72 hours were retrospectively analyzed. The poor functional outcome was defined as modified Rankin score mRS > 3 at 30 days. Receiver operating characteristic (ROC) curves for relative and absolute growth of HE were generated and compared. Multivariable logistic regression models were used to analyze the impact of HE on the functional outcome in basal ganglia and thalamic hemorrhages. The predictive values for different thresholds of HE were calculated, and correlation coefficient matrices were used to explore the correlation between the covariables. Results. Basal ganglia ICH showed a higher possibility of absolute hematoma growth than thalamic ICH. The area under the curve (AUC) for absolute and relative growth of thalamic hemorrhage was lower than that of basal ganglia hemorrhage (AUC 0.71 and 0.67, respectively) in discriminating short-term poor outcome with an AUC of 0.59 and 0.60, respectively. Each threshold of HE independently predicted poor outcome in basal ganglia ICH ( P < 0.001 ), with HE > 3 ml and > 6 ml showing higher positive predictive values and accuracy compared to HE > 33 % . In contrast, thalamic ICH had a smaller baseline volume (BV, 9.55 ± 6.85 ml ) and was more likely to initially involve the posterior limb of internal capsule (PLIC) (85/153, 57.82%), and the risk of HE was lower without PLIC involvement (4.76%, P = 0.009 ). Therefore, in multivariate analysis, the effect of thalamic HE on poor prognosis was largely replaced by BV and the involvement of PLIC, and the adjusted odds ratios (ORs) of HE was not significant ( P > 0.05 ). Conclusion. Though HE is a high-risk factor for short-term poor functional outcome, it is not an independent risk factor in thalamic ICH, and absolute growth is more predictive of poor outcome than relative growth for basal ganglia ICH.

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Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome

Neurology ◽

10.1212/wnl.0000000000010660 ◽

2020 ◽

Vol 95 (14) ◽

pp. 632-643 ◽

Cited By ~ 2

Author(s):

Andrea Morotti ◽

Francesco Arba ◽

Gregoire Boulouis ◽

Andreas Charidimou

Keyword(s):

Intracerebral Hemorrhage ◽

Randomized Controlled Trials ◽

Functional Outcome ◽

Meta Analysis ◽

Hematoma Expansion ◽

Controlled Trials ◽

Randomized Controlled ◽

Poor Outcome ◽

Increased Risk ◽

Noncontrast Ct

ObjectiveTo provide precise estimates of the association between noncontrast CT (NCCT) markers, hematoma expansion (HE), and functional outcome in patients presenting with intracerebral hemorrhage (ICH) through a systematic review and meta-analysis.MethodsWe searched PubMed for English-written observational studies or randomized controlled trials reporting data on NCCT markers of HE and outcome in spontaneous ICH including at least 50 subjects. The outcomes of interest were HE (hematoma growth >33%, >33% and/or >6 mL, >33% and/or >12.5 mL), poor functional outcome (modified Rankin Scale 3–6 or 4–6) at discharge or at 90 days, and mortality. We pooled data in random-effects models and extracted cumulative odds ratio (OR) for each NCCT marker.ResultsWe included 25 eligible studies (n = 10,650). The following markers were associated with increased risk of HE and poor outcome, respectively: black hole sign (OR = 3.70, 95% confidence interval [CI] = 1.42–9.64 and OR = 5.26, 95% CI = 1.75–15.76), swirl sign (OR = 3.33, 95% CI = 2.42–4.60 and OR = 3.70; 95% CI = 2.47–5.55), heterogeneous density (OR = 2.74; 95% CI = 1.71–4.39 and OR = 2.80; 95% CI = 1.78–4.39), blend sign (OR = 3.49; 95% CI = 2.20–5.55 and OR = 2.21; 95% CI 1.16–4.18), hypodensities (OR = 3.47; 95% CI = 2.18–5.50 and OR = 2.94; 95% CI = 2.28–3.78), irregular shape (OR = 2.01, 95% CI = 1.27–3.19 and OR = 3.43; 95% CI = 2.33–5.03), and island sign (OR = 7.87, 95% CI = 2.17–28.47 and OR = 6.05, 95% CI = 4.44–8.24).ConclusionOur results suggest that multiple NCCT ICH shape and density features, with different effect size, are important markers for HE and clinical outcome and may provide useful information for future randomized controlled trials.

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Prediction of Hematoma Expansion in Patients With Intracerebral Hemorrhage Using Thromboelastography With Platelet Mapping: A Prospective Observational Study

Frontiers in Neurology ◽

10.3389/fneur.2021.746024 ◽

2021 ◽

Vol 12 ◽

Author(s):

Qiuguang He ◽

You Zhou ◽

Chang Liu ◽

Zhongqiu Chen ◽

Rong Wen ◽

...

Keyword(s):

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Platelet Function ◽

Mediation Analysis ◽

Adenosine Diphosphate ◽

Hematoma Expansion ◽

Platelet Response ◽

Multivariate Logistic Regression ◽

Roc Curve Analysis

Background and Purpose: The purpose of the study was to evaluate the usefulness of thromboelastography with platelet mapping (TEG-PM) for predicting hematoma expansion (HE) and poor functional outcome in patients with intracerebral hemorrhage (ICH).Methods: Patients with primary ICH who underwent baseline computed tomography (CT) and TEG-PM within 6 h after symptom onset were enrolled in the observational cohort study. We performed univariate and multivariate logistic regression models to assess the association of admission platelet function with HE and functional outcome. In addition, a receiver operating characteristic (ROC) curve analysis investigated the accuracy of platelet function in predicting HE. A mediation analysis was undertaken to determine causal associations among platelet function, HE, and outcome.Results: Of 142 patients, 37 (26.1%) suffered HE. Multivariate logistic regression identified arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition as significant independent predictors of HE. The area under the ROC curves was 0.727 for AA inhibition and 0.721 for ADP inhibition. Optimal threshold for AA inhibition was 41.75% (75.7% sensitivity; 67.6% specificity) and ADP inhibition was 65.8% (73.0% sensitivity; 66.7% specificity). AA and ADP inhibition were also associated with worse 3-month outcomes after adjusting for age, admission Glasgow Coma Scale score, intraventricular hemorrhage, baseline hematoma volume, and hemoglobin. The mediation analysis showed that the effect of higher platelet inhibition with poor outcomes was mediated through HE.Conclusions: These findings suggest that the reduced platelet response to ADP and AA independently predict HE and poor outcome in patients with ICH. Platelet function may represent a modifiable target of ICH treatment.

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