Abstract 2653: Hypothermia For Intracerebral Hemorrhage: Mortality And Long-term Functional Outcome

Background Mild prolonged hypothermia reduces perihemorrhagic edema (PHE) growth and may improve survival after large intracerebral hemorrhage (ICH). However, functional outcome data are scarce and lower mortality after large ICH may be achieved at the cost of higher disability. We investigated the course of edema evolution and long term functional outcome in 22 consecutive patients with large ICH (>25ml) who were treated with hypothermia. Methods Mild endovascular hypothermia (35°C) was applied within 12h after symptom onset for a period of 10 days. PHE was measured on computed tomography scans using a semi-automatic threshold based algorithm. Outcome was assessed 90 days and one year after symptom onset. Results Twenty-two patients aged 62±9 years with spontaneous supratentorial ICH (58±25ml) received hypothermia. Volumetric analysis showed significantly less PHE in those patients during and after hypothermia, as compared to historical controls who did not receive hypothermia. Twenty patients (91%) survived until day 90 after symptom onset. One year after the bleeding event, eight patients had a modified Rankin scale (mRS) score of 3, eight patients had a mRS of 4, two patients a mRS of 5 and totally four patients had died. Conclusions Despite of large initial ICH size, patients treated with hypothermia showed a low mortality rate and eight patients (36%) were able to walk without assistance one year after ICH. Hypothermia may be a promising treatment approach in large ICH. An ongoing multicenter randomized clinical trial (CINCH) is investigating this treatment option.

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Functional Long-Term Outcome after Left- versus Right-Sided Intracerebral Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000454775 ◽

2017 ◽

Vol 43 (3-4) ◽

pp. 117-123 ◽

Cited By ~ 6

Author(s):

Vanessa D. Beuscher ◽

Joji B. Kuramatsu ◽

Stefan T. Gerner ◽

Julia Köhn ◽

Hannes Lücking ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Outcome Measures ◽

A Priori ◽

Term Outcome ◽

Long Term Outcome ◽

Excellent Outcome ◽

Confounding Variables ◽

Baseline Characteristics

Background and Purpose: Hemispheric location might influence outcome after intracerebral hemorrhage (ICH). INTERACT suggested higher short-term mortality in right hemispheric ICH, yet statistical imbalances were not addressed. This study aimed at determining the differences in long-term functional outcome in patients with right- vs. left-sided ICH with a priori-defined sub-analysis of lobar vs. deep bleedings. Methods: Data from a prospective hospital registry were analyzed including patients with ICH admitted between January 2006 and August 2014. Data were retrieved from institutional databases. Outcome was assessed using the modified Rankin Scale (mRS) score. Outcome measures (long-term mortality and functional outcome at 12 months) were correlated with ICH location and hemisphere, and the imbalances of baseline characteristics were addressed by propensity score matching. Results: A total of 831 patients with supratentorial ICH (429 left and 402 right) were analyzed. Regarding clinical baseline characteristics in the unadjusted overall cohort, there were differences in disfavor of right-sided ICH (antiplatelets: 25.2% in left ICH vs. 34.3% in right ICH; p < 0.01; previous ischemic stroke: 14.7% in left ICH vs. 19.7% in right ICH; p = 0.057; and presence/extent of intraventricular hemorrhage: 45.0% in left ICH vs. 53.0% in right ICH; p = 0.021; Graeb-score: 0 [0-4] in left ICH vs. 1 [0-5] in right ICH; p = 0.017). While there were no differences in mortality and in the proportion of patients with favorable vs. unfavorable outcome (mRS 0-3: 142/375 [37.9%] in left ICH vs. 117/362 [32.3%] in right ICH; p = 0.115), patients with left-sided ICH showed excellent outcome more frequently (mRS 0-1: 64/375 [17.1%] in left ICH vs. 43/362 [11.9%] in right ICH; p = 0.046) in the unadjusted analysis. After adjusting for confounding variables, a well-balanced group of patients (n = 360/hemisphere) was compared showing no differences in long-term functional outcome (mRS 0-3: 36.4% in left ICH vs. 33.9% in right ICH; p = 0.51). Sub-analyses of patients with deep vs. lobar ICH revealed also no differences in outcome measures (mRS 0-3: 53/151 [35.1%] in left deep ICH vs. 53/165 [32.1%] in right deep ICH; p = 0.58). Conclusion: Previously described differences in clinical end points among patients with left- vs. right-hemispheric ICH may be driven by different baseline characteristics rather than by functional deficits emerging from different hemispheric functions affected. After statistical corrections for confounding variables, there was no impact of hemispheric location on functional outcome after ICH.

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Declining Levels of Neutralizing Antibodies Against SARS-CoV-2 in Convalescent COVID-19 Patients One Year Post Symptom Onset

Frontiers in Immunology ◽

10.3389/fimmu.2021.708523 ◽

2021 ◽

Vol 12 ◽

Author(s):

Tiandan Xiang ◽

Boyun Liang ◽

Yaohui Fang ◽

Sihong Lu ◽

Sumeng Li ◽

...

Keyword(s):

Symptom Onset ◽

Neutralizing Antibodies ◽

Natural Infection ◽

Protein S ◽

Igg Antibodies ◽

Neutralizing Activity ◽

Specific Igg ◽

One Year ◽

Kinetics Of

Major advances have been made in understanding the dynamics of humoral immunity briefly after the acute coronavirus disease 2019 (COVID-19). However, knowledge concerning long-term kinetics of antibody responses in convalescent patients is limited. During a one-year period post symptom onset, we longitudinally collected 162 samples from 76 patients and quantified IgM and IgG antibodies recognizing the nucleocapsid (N) protein or the receptor binding domain (RBD) of the spike protein (S). After one year, approximately 90% of recovered patients still had detectable SARS-CoV-2-specific IgG antibodies recognizing N and RBD-S. Intriguingly, neutralizing activity was only detectable in ~43% of patients. When neutralization tests against the E484K-mutated variant of concern (VOC) B.1.351 (initially identified in South Africa) were performed among patients who neutralize the original virus, the capacity to neutralize was even further diminished to 22.6% of donors. Despite declining N- and S-specific IgG titers, a considerable fraction of recovered patients had detectable neutralizing activity one year after infection. However, neutralizing capacities, in particular against an E484K-mutated VOC were only detectable in a minority of patients one year after symptomatic COVID-19. Our findings shed light on the kinetics of long-term immune responses after natural SARS-CoV-2 infection and argue for vaccinations of individuals who experienced a natural infection to protect against emerging VOC.

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Decreased Time to Evacuation Improves Long Term Functional Outcome in Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Neurosurgery ◽

10.1093/neuros/nyz310_304 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Christopher P Kellner ◽

Rui Song ◽

Dominic A Nistal ◽

Ian T McNeill ◽

Hasitha M Samarage ◽

...

Keyword(s):

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

National Institutes Of Health ◽

Term Outcome ◽

Long Term Outcome ◽

Clinical Criteria ◽

Poor Outcome ◽

Deep Location

Abstract INTRODUCTION Preclinical and preliminary clinical data suggests that early minimally invasive intracerebral hemorrhage evacuation may convey a functional outcome benefit. Ongoing clinical trials permit an operative window extending out to 72 h. Here we present long term functional outcome after MIS endoscopic ICH evacuation with a focus on time to evacuation. METHODS Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit previously published clinical criteria including age = 18, National Institutes of Health Stroke Scale (NIHSS) = 6, hematoma volume = 15, and baseline modified Rankin Score (mRS) = 3 with a CTA negative for vascular malformation. Retrospective review was performed on patients who were treated in a single health system from December 2015 to August 2018. Demographic, clinical and radiographic previously demonstrated to impact ICH outcome were included in a multivariate logistic regression to identify factors predicting poor outcome (modified Rankin scale (mRS) 4-6) at 6 mo. RESULTS A total of 97 patients underwent minimally invasive endoscopic ICH evacuation. In a multivariate analysis, factors that predicted poor outcome included age (OR 1.81 (CI 1.15-3.08) P = .016), deep location (OR 11.1 (2.41-67.8) P = .004), presence of intraventricular hemorrhage (OR 5.81 (1.765-22.39) P = .006) and increased time to evacuation measured in hours (OR 1.048 (CI 1.017-1.084) P = .004). CONCLUSION Time to evacuation significantly impacts long term outcome in minimally invasive endoscopic ICH evacuation. Every minute counts.

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Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2058.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1270-1276

Author(s):

David N. Townshend ◽

Andrew J. F. Bing ◽

Timothy M. Clough ◽

Ian T. Sharpe ◽

Andy Goldberg ◽

...

Keyword(s):

Functional Outcome ◽

Early Experience ◽

Outcome Data ◽

Patient Specific ◽

Patient Specific Instrumentation ◽

Significant Difference ◽

Patient Reported ◽

The Mean ◽

One Year

Aims This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276.

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Abstract TP353: Long-term Outcomes in Patients With Intracerebral Hemorrhage and Delayed Hospital Presentation

Stroke ◽

10.1161/str.51.suppl_1.tp353 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michael E Reznik ◽

Scott Moody ◽

Brian Mac Grory ◽

Christoph Stretz ◽

Tracy E Madsen ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Symptom Onset ◽

Delayed Presentation ◽

Long Term Outcomes ◽

Factors Associated ◽

Emergency Department Arrival ◽

Survivorship Bias ◽

Prolonged Delay ◽

Using Data

Background: Delays in medical care are known to be associated with worse outcomes in ischemic stroke, but outcomes in patients with intracerebral hemorrhage (ICH) and delayed presentation are unclear. We aimed to determine factors associated with prolonged delays from ICH symptom onset to hospital presentation and implications for long-term outcomes. Methods: We performed a single-center cohort study using data from consecutive ICH patients over 12 months. ICH characteristics and outcomes were prospectively collected, while time of symptom onset (or last-known-well) and emergency department arrival were retrospectively abstracted. We calculated time-to-arrival and defined prolonged delay as >24 hours. Using multivariable logistic regression, we determined factors associated with prolonged delays to presentation, then determined associations with unfavorable 3-month outcomes (modified Rankin Scale [mRS] 4-6) after adjusting for demographics and ICH severity. Results: Of 299 patients with out-of-hospital ICH, 21% (n=62) presented >24 hours from symptom onset; median time-to-arrival was 5.5 hours (IQR 1.2-17.8). There were not significant differences in age (mean 71.9±14.0 vs. 70.4±16.0, p=0.50), sex (48% vs. 50% male, p=0.80), race (89% vs. 82% white, p=0.22), or ICH size (mean 15.5±23.2 vs. 20.5±27.4cc, p=0.19) between patients presenting >24 hours and <24 hours from symptom onset, though patients with prolonged delays were less likely to have initial GCS <13 (16% vs. 34%, p=0.02) and therefore had modestly lower ICH scores (median 1 [0-2] vs. 1 [1-2], p=0.02). Patients with prolonged delays had lower 3-month mRS scores than patients who presented earlier (median 3 [1.5-4] vs. 4 [3-6], p=0.002), and lower odds of unfavorable 3-month outcome in adjusted models (OR 0.46, 95% CI 0.22-0.97). Conclusions: Outcomes in ICH patients with prolonged delays to presentation differ from those who present earlier. ICH severity in such patients may not be accurately captured by established predictors, and prognostication models should therefore account for inherent survivorship bias.

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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 WP360: Race and Ethnicity Are Associated with Intracerebral Hemorrhage Recurrence Risk

Stroke ◽

10.1161/str.48.suppl_1.wp360 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Alessandro Biffi ◽

Jennifer Osborne ◽

Charles Moomaw ◽

Carl D Langefeld ◽

Daniel Woo ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Race And Ethnicity ◽

Recurrence Risk ◽

Recurrent Bleeding ◽

Critical Determinant ◽

Biological Determinants ◽

One Year ◽

Racial Ethnic

Introduction: Intracerebral Hemorrhage (ICH) has previously been shown to disproportionately affect African-American (AA) and Hispanic-American (HA) patients compared to White (W). ICH recurrence risk, while a critical determinant of long-term disability and mortality, has not been extensively studies among minority individuals. Hypothesis: We sought to clarify whether AA and HA patients are at higher risk for ICH recurrence, and whether etiological differences exist for rebleeding events in different racial / ethnic groups. Methods: We analyzed data for 1542 ICH survivors enrolled in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, who survived at least three months post-ICH and were followed for at least one year. Participants underwent scheduled follow-up at 10-16, 22-28 and 50-60 weeks after index ICH to identify recurrence events. ICH etiology (primarily hypertensive vs. primarily amyloid related) was determined on the basis of index hemorrhage location, i.e. lobar for amyloid and non-lobar for hypertensive bleeds. Results: We analyzed data for 1542 ICH survivors (W: n=514, AA: n=453, HA: n=565), and identified a total of 42 recurrent ICH events (2.72%). AA patients were at higher risk for ICH recurrence compared to W (3.75% vs. 2.10%, p = 0.012), while HA were not (2.20% vs. 2.10%, p=0.78). Self-identified AA race/ethnicity was associated with greater risk for non-lobar ICH (Hazard Ratio [HR]=2.77, p=0.008) than lobar ICH (HR=1.43, p=0.048). Conclusions: AA ICH survivors are at higher risk for recurrent bleeding, and particularly for non-lobar hypertensive hemorrhages. These findings highlight the need for dedicated studies investigating the biological determinants of ICH recurrence in different racial/ethnic patient populations.

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Determining ICH Score: can we go beyond?

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000400006 ◽

2009 ◽

Vol 67 (3a) ◽

pp. 605-608 ◽

Cited By ~ 10

Author(s):

Gustavo Cartaxo Patriota ◽

João Manoel da Silva-Júnior ◽

Alécio Cristino Evangelista Santos Barcellos ◽

Joaquim Barbosa de Sousa Silva Júnior ◽

Diogo Oliveira Toledo ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Auxiliary Variable ◽

Accurate Information ◽

Spontaneous Intracerebral Hemorrhage ◽

Great Heterogeneity ◽

One Year ◽

The One ◽

Ich Score ◽

Reliable Scale

Spontaneous intracerebral hemorrhage (SICH) still presents a great heterogeneity in its clinical evaluation, demonstrating differences in the enrollment criteria used for the study of intracerebral hemorrhage (ICH) treatment. The aim of the current study was to assess the ICH Score, a simple and reliable scale, determining the 30-day mortality and the one-year functional outcome. Consecutive patients admitted with acute SICH were prospectively included in the study. ICH Scores ranged from 0 to 4, and each increase in the ICH Score was associated with an increase in the 30-day mortality and with a progressive decrease in good functional outcome rates. However, the occurrence of a pyramidal pathway injury was better related to worse functional outcome than the ICH Score. The ICH Score is a good predictor of 30-day mortality and functional outcome, confirming its validity in a different socioeconomic populations. The association of the pyramidal pathway injury as an auxiliary variable provides more accurate information about the prognostic evolution.

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Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000479075 ◽

2017 ◽

Vol 44 (3-4) ◽

pp. 186-194 ◽

Cited By ~ 5

Author(s):

Maximilian I. Sprügel ◽

Joji B. Kuramatsu ◽

Stefan T. Gerner ◽

Jochen A. Sembill ◽

Julius Hartwich ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

De Novo ◽

Clinical History ◽

Term Outcome ◽

Cancer Disease ◽

Long Term Outcome ◽

Patients With Cancer ◽

Treatment Restrictions

Background: Data on clinical characteristics and outcome of patients with intracerebral hemorrhage (ICH) and concomitant systemic cancer disease are very limited. Methods: Nine hundred and seventy three consecutive primary ICH patients were analyzed using our prospective institutional registry over a period of 9 years (2006-2014). We compared clinical and radiological parameters as well as outcome - scored using the modified Rankin Scale (mRS) and analyzed in a dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable outcome (mRS = 4-6) - of ICH patients with and without cancer. Relevant imbalances in baseline clinical and radiological characteristics were adjusted using propensity score (PS) matching. Results: Prevalence of systemic cancer among patients with ICH was 8.5% (83/973). ICH patients with cancer were older (77 [70-82] vs. 72 [63-80] years; p = 0.002), had more often prior renal dysfunction (19/83 [22.9%] vs.107/890 [12.0%]; p = 0.005), and smaller hemorrhage volumes (10.1 [4.8-24.3] vs. 15.3 [5.4-42.9] mL; p = 0.017). After PS-matching there were no significant differences neither in mortality nor in functional outcome both at 3 months (mortality: 33/81 [40.7%] vs. 55/158 [34.8%]; p = 0.368; mRS = 0-3: 28/81 [34.6%] vs. 52/158 [32.9%]; p = 0.797) and 12 months (mortality: 39/78 [50.0%] vs. 70/150 [46.7%]; p = 0.633; mRS = 0-3: 25/78 [32.1%] vs. 53/150 [35.3%]; p = 0.620) among patients with and without concomitant systemic cancer. ICH volume tended to be highest in patients with hematooncologic malignancy and smallest in urothelial cancer. Conclusions: Patients with ICH and concomitant systemic cancer on average are older; however, they show smaller ICH volumes compared to patients without cancer. Yet, mortality and functional outcome is not different in ICH patients with and without cancer. Thus, the clinical history or the de novo diagnosis of concomitant malignancies in ICH patients should not lead to unjustified treatment restrictions.

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