Abstract TP310: Subarachnoid Extension of Intracerebral Hemorrhage and Perihematomal Ischemic Compression Are Related, Harmful Processes

Background: Decreased diffusion is associated with poor outcomes in primary intracerebral hemorrhage (ICH), although the mechanism of that phenomenon is uncertain. Two distinct types of decreased diffusion have been observed, perihematomal ischemia (PHI) and distant areas of ischemia. Extension of hemorrhage into the subarachnoid (SAH) and intraventricular (IVH) compartments may be indicators of high perihematomal pressures and diminished brain parenchyma compliance. The objective of this study is to evaluate for an association between PHI and poor outcomes, and to evaluate whether PHI is associated with SAH and IVH as markers of injurious perihematomal pressure. Methods: Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. MRI was performed on all salvageable patients when possible. SAH, IVH and PHI were identified on imaging, along with ICH volumes, by expert reviewers blinded to outcomes. An ordinal regression model was used to evaluate for an association between PHI and modified Rankin Scale (mRS) at 28 days, adjusted for ICH Score. A binary logistic regression models was developed to identify an association between PHI and other potential predictors of malignant peri-hematomal pressures: SAH, IVH, initial hematoma volume, and supra- versus infratentorial location. Results: 94 patients were studied. 27 (28.7%) had SAH and 44 (46.8%) had IVH. PHI was associated with mRS at 28 days (odds ratio 2.88 [95% CI 1.23-6.75]), independent of ICH Score. PHI was associated with SAH (3.74 [1.25-11.21]), whereas no significant association was found with IVH, hematoma volume or location. Conclusions: PHI is independently associated with poor outcomes in primary ICH. PHI is associated with SAH, but not hemorrhage volume, location or decompression into the ventricular system. These findings suggest that PHI and subarachnoid hemorrhage extension are associated, unique markers for injurious perihematomal pressure.

Download Full-text

Low hemoglobin and hematoma expansion after intracerebral hemorrhage

Neurology ◽

10.1212/wnl.0000000000007820 ◽

2019 ◽

Vol 93 (4) ◽

pp. e372-e380 ◽

Cited By ~ 5

Author(s):

David J. Roh ◽

David J. Albers ◽

Jessica Magid-Bernstein ◽

Kevin Doyle ◽

Eldad Hod ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Mediation Analysis ◽

Regression Models ◽

Hematoma Expansion ◽

Inclusion Criteria ◽

Logistic Regression Models ◽

Neuroimaging Data ◽

Poor Outcomes ◽

Ich Score ◽

Antithrombotic Medication

ObjectiveStudies have independently shown associations of lower hemoglobin levels with larger admission intracerebral hemorrhage (ICH) volumes and worse outcomes. We investigated whether lower admission hemoglobin levels are associated with more hematoma expansion (HE) after ICH and whether this mediates lower hemoglobin levels' association with worse outcomes.MethodsConsecutive patients enrolled between 2009 and 2016 to a single-center prospective ICH cohort study with admission hemoglobin and neuroimaging data to calculate HE (>33% or >6 mL) were evaluated. The association of admission hemoglobin levels with HE and poor clinical outcomes using modified Rankin Scale (mRS 4–6) were assessed using separate multivariable logistic regression models. Mediation analysis investigated causal associations among hemoglobin, HE, and outcome.ResultsOf 256 patients with ICH meeting inclusion criteria, 63 (25%) had HE. Lower hemoglobin levels were associated with increased odds of HE (odds ratio [OR] 0.80 per 1.0 g/dL change of hemoglobin; 95% confidence interval [CI] 0.67–0.97) after adjusting for previously identified covariates of HE (admission hematoma volume, antithrombotic medication use, symptom onset to admission CT time) and hemoglobin (age, sex). Lower hemoglobin was also associated with worse 3-month outcomes (OR 0.76 per 1.0 g/dL change of hemoglobin; 95% CI 0.62–0.94) after adjusting for ICH score. Mediation analysis revealed that associations of lower hemoglobin with poor outcomes were mediated by HE (p = 0.01).ConclusionsFurther work is required to replicate the associations of lower admission hemoglobin levels with increased odds of HE mediating worse outcomes after ICH. If confirmed, an investigation into whether hemoglobin levels can be a modifiable target of treatment to improve ICH outcomes may be warranted.

Download Full-text

Serum glucose and potassium ratio as a predictive factor for prognosis of acute intracerebral hemorrhage

Journal of International Medical Research ◽

10.1177/03000605211009689 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110096

Author(s):

Xiao-Yu Wu ◽

Yao-Kun Zhuang ◽

Yong Cai ◽

Xiao-Qiao Dong ◽

Ke-Yi Wang ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Characteristic Curve ◽

Serum Glucose ◽

Clinical Variable ◽

Hematoma Volume ◽

Nihss Score ◽

Patients At Risk ◽

Acute Intracerebral Hemorrhage ◽

Poor Outcomes ◽

Gcs Score

Objective The serum glucose/potassium ratio (GPR) is a potential prognostic predictor for acute brain injury-related diseases. We calculated the serum GPR in patients with acute intracerebral hemorrhage (ICH) and explored its prognostic value for long-term prognoses and ICH severity. Methods This retrospective cohort study consecutively included 92 patients with ICH and 92 healthy controls. The National Institutes of Health Stroke Scale (NIHSS) score, Glasgow coma scale (GCS) score, and hematoma volume were used to assess severity. A modified Rankin Scale score > 2 at 90 days post-stroke was defined as a poor outcome. Results The serum GPR was significantly higher in patients than controls. The serum GPR was weakly correlated with the NIHSS score, GCS score, and hematoma volume. The serum GPR, GCS score, and hematoma volume were independently associated with poor outcomes. In the receiver operating characteristic curve analysis, the serum GPR remarkably discriminated patients at risk of poor outcomes at 90 days. The serum GPR significantly improved the prognostic predictive capability of hematoma volume and tended to increase that of the GCS score. Conclusion Serum GPR is an easily obtained clinical variable for predicting clinical outcomes after ICH.

Download Full-text

Systemic inflammatory response syndrome, infection, and outcome in intracerebral hemorrhage

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000428 ◽

2017 ◽

Vol 5 (2) ◽

pp. e428 ◽

Cited By ~ 6

Author(s):

Amelia K. Boehme ◽

Mary E. Comeau ◽

Carl D. Langefeld ◽

Aaron Lord ◽

Charles J. Moomaw ◽

...

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Intracerebral Hemorrhage ◽

Systemic Inflammatory Response ◽

Infection Age ◽

Racial Variations ◽

Poor Outcomes ◽

Ich Score ◽

The Relationship ◽

Admission Glasgow Coma Scale

Objective:Systemic inflammatory response syndrome (SIRS) may be related to poor outcomes after intracerebral hemorrhage (ICH).Methods:The Ethnic/Racial Variations of Intracerebral Hemorrhage study is an observational study of ICH in whites, blacks, and Hispanics throughout the United Sates. SIRS was defined by standard criteria as 2 or more of the following on admission: (1) body temperature <36°C or >38°C, (2) heart rate >90 beats per minute, (3) respiratory rate >20 breaths per minute, or (4) white blood cell count <4,000/mm3 or >12,000/mm3. The relationship among SIRS, infection, and poor outcome (modified Rankin Scale [mRS] 3–6) at discharge and 3 months was assessed.Results:Of 2,441 patients included, 343 (14%) met SIRS criteria at admission. Patients with SIRS were younger (58.2 vs 62.7 years; p < 0.0001) and more likely to have intraventricular hemorrhage (IVH; 53.6% vs 36.7%; p < 0.0001), higher admission hematoma volume (25.4 vs 17.5 mL; p < 0.0001), and lower admission Glasgow Coma Scale (GCS; 10.7 vs 13.1; p < 0.0001). SIRS on admission was significantly related to infections during hospitalization (adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.04–1.78). In unadjusted analyses, SIRS was associated with poor outcomes at discharge (OR 1.96, 95% CI 1.42–2.70) and 3 months (OR 1.75, 95% CI 1.35–2.33) after ICH. In analyses adjusted for infection, age, IVH, hematoma location, admission GCS, and premorbid mRS, SIRS was no longer associated with poor outcomes.Conclusions:SIRS on admission is associated with ICH score on admission and infection, but it was not an independent predictor of poor functional outcomes after ICH.

Download Full-text

Abstract TP451: Intracerebral Hemorrhage Volume Predicts Neurological Pupil Index

Stroke ◽

10.1161/str.51.suppl_1.tp451 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Venkatesh Aiyagari ◽

Khadijah Mazhar ◽

Daiwai Olson ◽

Sonja Stutzman ◽

James Moreno ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Neurocritical Care ◽

Mass Effect ◽

Hematoma Expansion ◽

Midline Shift ◽

Hematoma Volume ◽

Hemorrhage Volume ◽

The Mean ◽

Neurological Pupil Index

Introduction: Hand-held automated pupillometry reliably evaluates the pupillary light reflex (PLR) at the bedside and there is growing interest in studying its ability to detect midline shift and mass effect. We hypothesized that intracerebral hemorrhage (ICH) volume would correlate with objective measures of PLR, specifically the Neurological Pupil index (NPi). Methods: This was a retrospective study of ICH patients with serial pupillometer readings admitted to the Neurocritical Care Unit and enrolled in the END-PANIC registry. CT images were examined to measure hematoma volume using the simplified ABC/2 method, midline shift, hydrocephalus score, and Graeb score to measure interventricular hemorrhage. Demographics were examined with standard measures of central tendency, hypotheses with logistic regression, categorical data with Fisher’s Exact X 2 , and multivariate modeling with constructed MAX-R models. Results: Of 44 subjects, 50% were male and the mean age was 65.4 years. ICH location was deep in 56.8% and lobar in 43.2%. There was a significant correlation between ICH volume and NPi of the pupil ipsilateral (r 2 =0.48, p<0.0001) and contralateral (r 2 =0.39, p<0.0001) to the hematoma. Shift of the septum pellucidum also correlated with NPi (ipsilateral[r 2 =0.25, p=0.0006], contralateral[r 2 =0.15, p=0.0106]), as did shift of the pineal gland (ipsilateral[r 2 =0.21, p=0.0017], contralateral[r 2 =0.11, p=0.0328]). No statistically significant correlation was found between hydrocephalus score or Graeb score and NPi. ICH volume was the most predictive of abnormal NPi (Figure 1). Conclusions: The NPi correlates with ICH volume and shift of midline structures. Abnormalities in NPi can be predicted by hematoma volume. Future studies should explore the role of NPi in detecting hematoma expansion and worsening midline shift.

Download Full-text

Abstract TP309: Subarachnoid Extension of Hemorrhage Is Associated with Poor Outcomes in Primary Intracerebral Hemorrhage

Stroke ◽

10.1161/str.44.suppl_1.atp309 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Matthew B Maas ◽

Alexander J Nemeth ◽

Neil F Rosenberg ◽

Adam R Kosteva ◽

James C Guth ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcomes ◽

Regression Models ◽

Scale Scores ◽

Unknown Significance ◽

Clinical Consequences ◽

Lobar Hemorrhage ◽

Underlying Mechanisms ◽

Poor Outcomes ◽

Ich Score

Background: Extension of hemorrhage into the subarachnoid space is observed in primary intracerebral hemorrhage (ICH), yet the phenomenon has undergone limited study and is of unknown significance. The objective of this study is to evaluate the incidence, characteristics and clinical consequences of subarachnoid hemorrhage extension (SAHE) in ICH. Methods: Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. SAHE was identified on imaging, along with ICH volumes, by expert reviewers blinded to outcomes. Ordinal regression models were developed to test whether the occurrence of SAHE was a predictor of functional outcomes independent of ICH Score, with confirmation of model validity by appropriate tests. Results: 234 patients were studied, and 93 (39.7%) had SAHE. SAHE was associated with lobar hemorrhage location (65% of SAHE versus 19% of non-SAHE cases, p<0.001), and larger hematoma volumes (median 23.8 versus 6.65, p<0.001). SAHE was a predictor of higher modified Rankin Scale scores (mRS) at discharge (odds ratio 2.22 per mRS point [95% CI 1.29-3.81]) and 28 days (1.80 [1.04-3.11]) after adjustment for ICH Score. Conclusions: SAHE is associated with poor outcomes independent of traditional ICH severity measures. Further exploration of this phenomenon to understand the underlying mechanisms of harm is needed.

Download Full-text

Abstract WP355: Predictors and Outcome of Intubation for Patients with Primary Intracerebral Hemorrhage

Stroke ◽

10.1161/str.48.suppl_1.wp355 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ayaz Khawaja ◽

Anand Venkatraman ◽

Maira Mirza

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcomes ◽

Primary Outcome ◽

Hemorrhagic Transformation ◽

Hematoma Expansion ◽

Optimal Timing ◽

Airway Compromise ◽

Epidural Hemorrhage ◽

Poor Outcomes ◽

Ich Score

Background: Patients with primary intracerebral hemorrhage (pICH) are at risk of airway compromise and commonly undergo intubation. Poor outcomes have been reported for these patients. Factors predicting intubation prior to admission (PTA), and after admission are unknown. These factors may be helpful in predicting which pICH patients require intubation, and its optimal timing. Methods: Patients with pICH directly admitted or transferred from another facility to our center were included. Patients with SAH, SDH, epidural hemorrhage, underlying lesions, or infarct with hemorrhagic transformation were excluded. Intubation note from medical chart was used to determine the timing of intubation. Demographic and clinical data were recorded. The primary outcome was a discharge mRS (dmRS) of 4-6. Results: A total of 370 patients were included. Patients intubated PTA had a lower average GCS (6 vs. 9; p=0.0003) and a higher average NIHSS (26 vs. 18; p=0.0007) than those intubated after admission. Higher incidences of hematoma expansion (30.9% vs. 16.3%; p=0.0253), tracheostomies performed (17.5% vs. 4.8%; p=0.0004), ICH volumes > 30cc (40% vs. 25.5%; p=0.0352), and pneumonia (35.1% vs. 5.4%; p<0.0001) were seen in patients intubation after admission, when compared to other patients. Patients requiring intubation at any time had statistically non-significant higher incidences of cortical and brainstem hemorrhage (see Table 1), compared to patients not intubated. After adjusting for pneumonia and ICH score, intubation is significantly associated with a dmRS of 4-6 (OR 4.87, 95%CI 1.27-18.7, p=0.0208). Conclusions: Lower GCS and higher NIHSS significantly predict intubation in pICH patients PTA. ICH volumes > 30cc, hematoma expansion and pneumonia significantly predict intubation after admission. Intubation is significantly associated with poor functional outcomes independent of ICH score and pneumonia. Location of ICH does not predict intubation.

Download Full-text

Abstract 148: Evaluation of Sex, Racial and Geographic Demographics and Outcomes in Clinical Trials of Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/str.48.suppl_1.148 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lauren Koffman ◽

Daniel Hanley ◽

Craig Anderson ◽

David Mendelow ◽

Barbara Gregson ◽

...

Keyword(s):

Clinical Trials ◽

Intracerebral Hemorrhage ◽

Disease Process ◽

Geographic Location ◽

Pooled Analysis ◽

Spontaneous Intracerebral Hemorrhage ◽

Representation Of Women ◽

Artery Disease ◽

Poor Outcomes ◽

Ich Score

Introduction: As large clinical trials for spontaneous intracerebral hemorrhage (ICH) increasingly influence management, recruitment of diverse populations must be ensured to fully understand the disease process and benefit of interventions to the general public. There is little data on sex, race and outcomes in ICH trials. We hypothesize that women and geographic minorities are underrepresented in ICH clinical trials and that there exist population specific differences in mortality, functional outcomes and response to interventions. Methods: Pooled analysis of 5456 subjects from the following clinical trials: VISTA (985), INTERACT I (404) and II (2829), STICH II (597), MISTIE II (141) and CLEAR III (500). Patients were grouped by sex, race, and geographic location. Modified Rankin Scale [mRS] was obtained at 30 days and 3 months. Results: More men than women participated in ICH trials (61.9% vs. 38.1%); women were older and more likely to have hypertension; men had more coronary artery disease. Women presented with lower Glasgow Coma scale, higher ICH score and more intraventricular hemorrhage. Day 90 mortality was 13.9% in women and 16.6 % in men (p=0.01); 90 day poor outcome (mRS 3-5) was 57.2% in women and 51.0% in men (p<0.001). Only mortality was significantly different between sexes after adjustment for ICH score. Race representation varied in these clinical trials: 1.5% Hispanic; 6.6% black; 14% Arabic; 31% white and 43.4% Asian. Day 90 mortality and mRS 3-5 were highest in Hispanics (22.1%, 78.3%, respectively) and lowest in Asians (9.5%, 43.8%). Hispanics had higher ICH score, but blacks and Hispanics had lower day 90 mortality compared to whites in adjusted models. Asians had both lower mortality and less day 90 mRS 3-5 vs. whites while Arabics and blacks were more likely to have day 90 mRS 3-5. Study interventions were well balanced by sex and race. Conclusions: Sex and race representation in ICH clinical trials only partially equate to current understanding of epidemiology of ICH. There is a lack of trial evidence from Africa and South America and under-representation of women, Hispanics and blacks. Despite higher ICH severity, Hispanics had lower adjusted mortality risk while males had higher risk and Arabics and blacks had worse adjusted poor outcomes.

Download Full-text

Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.98205 ◽

2012 ◽

Vol 03 (02) ◽

pp. 115-120 ◽

Cited By ~ 6

Author(s):

Michel Lelo Tshikwela ◽

Benjamin Longo-Mbenza

Keyword(s):

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Accurate Method ◽

Mortality Prediction ◽

High Rate ◽

Midline Shift ◽

Logistic Regression Models ◽

Influence Model ◽

Men 2 ◽

Ich Score

ABSTRACT Background and Purpose: Intracerebral hemorrhage (ICH) constitutes now 52% of all strokes. Despite of its deadly pattern, locally there is no clinical grading scale for ICH-related mortality prediction. The first objective of this study was to develop a risk stratification scale (Kinshasa ICH score) by assessing the strength of independent predictors and their association with in-hospital 30-day mortality. The second objective of the study was to create a specific local and African model for ICH prognosis. Materials and Methods: Age, sex, hypertension, type 2 diabetes mellitus (T2DM), smoking, alcohol intake, and neuroimaging data from CT scan (ICH volume, Midline shift) of patients admitted with primary ICH and follow-upped in 33 hospitals of Kinshasa, DR Congo, from 2005 to 2008, were analyzed using logistic regression models. Results: A total of 185 adults and known hypertensive patients (140 men and 45 women) were examined. 30-day mortality rate was 35% (n=65). ICH volume>25 mL (OR=8 95% CI: 3.1-20.2; P<0.0001), presence of coma (OR=6.8 95% CI 2.6-17.4; P<0.0001) and left hemispheric site of ICH (OR 2.6 95% CI: 1.1-6; P=0.027) were identified as significant and independent predictors of 30-day mortality. Midline shift > 7 mm, a consequence of ICH volume, was also a significant predictor of mortality. The Kinshasa ICH score was the sum of individual points assigned as follows: Presence of coma coded 2 (2 × 2 = 4), absence of coma coded 1 (1 × 2 = 2), ICH volume>25 mL coded 2 (2 × 2=4), ICH volume of ≤25 mL coded 1(1 × 2=2), left hemispheric site of ICH coded 2 (2 × 1=2), and right hemispheric site of hemorrhage coded 1(1 × 1 = 1). All patients with Kinshasa ICH score ≤7 survived and the patients with a score >7 died. In considering sex influence (Model 3), points were allowed as follows: Presence of coma (2 × 3 = 6), absence of coma (1 × 3 = 3), men (2 × 2 = 4), women (1 × 2 = 2), midline shift ≤7 mm (1 × 3 = 3), and midline shift >7 mm (2 × 3 = 6). Patients who died had the Kinshasa ICH score ≥16. Conclusion: In this study, the Kinshasa ICH score seems to be an accurate method for distinguishing those ICH patients who need continuous and special management. It needs to be validated among large African hypertensive populations with a high rate of 30-day in–hospital mortality.

Download Full-text

Refining Prognosis for Intracerebral Hemorrhage by Early Reassessment

Cerebrovascular Diseases ◽

10.1159/000452679 ◽

2017 ◽

Vol 43 (3-4) ◽

pp. 110-116 ◽

Cited By ~ 18

Author(s):

Matthew B. Maas ◽

Brandon A. Francis ◽

Rajbeer S. Sangha ◽

Bryan D. Lizza ◽

Eric M. Liotta ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Prognostic Score ◽

Observational Cohort Study ◽

Predictors Of Outcome ◽

Neurologic Injury ◽

Ordinal Regression Model ◽

Observational Cohort ◽

Ich Score ◽

Gcs Score ◽

Z Transformation

Background: Prognostic assessments, which are crucial for decision-making in critical illnesses, have shown unsatisfactory reliability. We compared the accuracy of a widely used prognostic score against a model derived from clinical data obtained 5 days after admission for patients with intracerebral hemorrhage (ICH), a condition for which prognostication has proven notoriously challenging and prone to bias. Methods: Patients enrolled in a prospective observational cohort study of spontaneous ICH underwent hourly Glasgow Coma Scale (GCS) assessment. Outcome was measured at 3 months using the modified Rankin Scale (mRS). We analyzed the change in correlation between GCS and 3-month mRS scores from admission through day 5, and compared the performance of a parsimonious set of day 5 clinical variables against the ICH score. Results: Data was collected on 254 subjects. The ICH score and day 5 GCS score were both correlated with 3-month mRS score (p < 0.001), but the correlation was stronger with day 5 GCS score (p < 0.05 by Fisher z-transformation). Premorbid mRS score, intraventricular hemorrhage and day 5 GCS score were independent predictors of outcome (all p < 0.05 in ordinal regression model). While ICH score correctly classified good (mRS 0-3) vs. poor (mRS 4-6) outcome in 73% of cases, the day 5 model correctly classified 83% of cases. Conclusions: A simple reassessment after 5 days of care significantly improves the accuracy of prognosticating outcome in patients with ICH. These data confirm the feasibility and potential utility of early reassessments in refining prognosis for patients who survive early stabilization of a severe neurologic injury.

Download Full-text

Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

International Journal of Stroke ◽

10.1177/1747493019830589 ◽

2019 ◽

Vol 15 (1) ◽

pp. 90-102 ◽

Cited By ~ 2

Author(s):

Natasha Ironside ◽

Ching-Jen Chen ◽

Victoria Dreyer ◽

Brandon Christophe ◽

Thomas J Buell ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Dependence ◽

Characteristic Curve ◽

Receiver Operator Characteristic Curve ◽

Independent Effect ◽

Study Cohort ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume ◽

Multivariable Regression ◽

Ich Score

Background and objective Functional outcome after spontaneous intracerebral hemorrhage (ICH) may vary depending on hematoma volume and location. We assessed the interaction between hematoma volume and location, and modified the original ICH score to include such an interaction. Methods Consecutive ICH patients were enrolled in the Intracerebral Hemorrhage Outcomes Project from 2009 to 2017. Inclusion criteria were age≥18 years, baseline modified Rankin Scale (mRS) score 0–2, neuroimaging, and follow-up. Functional dependence and mortality were defined as 90-day mRS>2 and death, respectively. A location ICH score was developed using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses. Results The study cohort comprised 311 patients, and the derivation and validation cohorts comprised 209 and 102 patients, respectively. Interactions between hematoma volume and location predicted functional dependence ( p = 0.008) and mortality ( p = 0.025). The location ICH score comprised age≥80 years (1 point), Glasgow Coma Scale score (3–9 = 2 points; 10–13 = 1 point), volume–location (lobar:≥24 mL=2 points, 21–24 mL=1 point; deep:≥8 mL=2 points, 7–8 mL=1 point; brainstem:≥6 mL=2 points, 3–6 mL=1 point; cerebellum:≥24 mL=2 points, 12–24 mL=1 point), and intraventricular hemorrhage (1 point). AUROC of the location ICH score was higher in functional dependence (0.883 vs. 0.770, p = 0.002) but not mortality (0.838 vs. 0.841, p = 0.918) discrimination compared to the original ICH score. Conclusions The interaction between hematoma volume and location exerted an independent effect on outcomes. Excellent discrimination of functional dependence and mortality was observed with incorporation of location-specific volume thresholds into a prediction model. Therefore, the volume–location relationship plays an important role in ICH outcome prediction.

Download Full-text