Abstract WP345: Pretreatment with Sulfonylurea Drugs is Associated with Smaller Baseline Hematoma Volumes and Better Functional Outcomes in Diabetic Patients with Acute Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason J Chang ◽  
Yasser Khorchid ◽  
Ali Kerro ◽  
Lucia G Burgess ◽  
Nitin Goyal ◽  
...  
Keyword(s):  
Linear Regression ◽  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Cerebral Edema ◽  
Regression Models ◽  
Tertiary Care ◽  
Diabetic Patients ◽  
Inclusion Criteria ◽  
Ich Score

Introduction: Intracerebral hemorrhage (ICH) is associated with worse clinical outcome and high mortality. Secondary mechanisms of injury promoting cerebral edema play a major role. One proposed mechanism for cerebral edema lies with sulfonylurea receptor 1 (SUR1), which is upregulated in focal cerebral ischemia and leads to passive vasogenic edema. Sulfonylureas (SFU) inhibit SUR1, and recent results of GAMES-Pilot trial indicate that they may also provide neuroprotection against malignant cerebral edema and improve clinical outcome in ischemic stroke. We sought to evaluate the association of prehospital SFU use with outcomes in diabetic (DM) patients with acute ICH. Methods: We retrospectively analyzed a prospective cohort of patients presenting with acute (<24 hrs) ICH at a tertiary care center. Study inclusion criteria included history of DM, spontaneous ICH etiology, and age > 18 yo. Baseline ICH severity was documented using ICH-score. Hematoma volumes (HV) on admission were calculated using ABC/2 formula. Unfavorable functional outcome was documented as a mRS score of 2-6 at discharge. Results: 230 patients with ICH and DM fulfilled inclusion criteria; 37 patients were pretreated with SFU (mean age 67 ±10 years, male 41%). Patients with SFU pretreatment had significantly ( p <0.05) lower median ICH-score (1 point, IQR: 0-2) and median admission HV (4cm 3 , IQR:1-12) compared to controls [ICH-score: 1 point (IQR:0-3); HV: 9 cm 3 (IQR:3-20)]. Unfavorable functional outcome was less common in SFU pretreated patients (49% vs 81 %; p =0.004). SFU pretreatment was independently ( p =0.043) and negatively associated with the natural logarithm of admission HV (linear regression coefficient: -0.62; 95%CI: -0.02, -1.23) in multiple linear regression models adjusting for potential confounders. Pretreatment with SFU was also independently ( p =0.013) associated with lower likelihood of unfavorable functional (OR: 0.12; 95%CI: 0.02, 0.64) outcome in multivariable logistic regression models adjusting for potential confounders. Conclusions: Pretreatment with SFU may be an independent predictor for smaller hematoma volume and improved functional outcome in diabetic patients with acute ICH. This association requires independent confirmation.

scholarly journals Low hemoglobin and hematoma expansion after intracerebral hemorrhage

Neurology ◽  
2019 ◽  
Vol 93 (4) ◽  
pp. e372-e380 ◽  
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.

Abstract TP332: Intracerebral Hemorrhage Volume to Edema Volume Ratio Predicts Poor Functional Outcome in Young Patients with Non-Lobar Primary Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Angela Hays Shapshak ◽  
April Sisson ◽  
Mini Singh ◽  
Michael J Lyerly ◽  
Karen Albright
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Cerebral Edema ◽  
Young Patients ◽  
Volume Ratio ◽  
Midline Shift ◽  
Poor Functional Outcome ◽  
Edema Volume ◽  
Imaging Characteristics ◽  
Ich Score

Background and Purpose: Cerebral edema is known to contribute to clinical decline in patients with spontaneous ICH. We sought to evaluate the significance of cerebral edema on outcome in young patients with primary ICH. Methods: We performed a retrospective review of patients presenting to our CSC center from 2014-2015 with primary ICH, excluding patients with lobar ICH and age 55 and above. Patients were grouped according to functional outcome at discharge (mRS 0-3 vs. 4-6). Imaging characteristics of those with poor short-term functional outcome (mRS 4-6) were compared to those with mRS 0-3. Receiver Operating Characteristics curves were used to evaluate the discriminatory ability of imaging characteristics with regards to poor functional outcome. Results: A total of 38 patients met inclusion criteria (mean age 47, 42% black, 55% male). On presentation, patients with poor functional outcome had larger mean ICH volume (26 vs 9cc; p=0.020), higher ICH volume to edema volume ratios (2.0 vs. 0.7, p=0.010), more evidence of midline shift (38% vs. 6%, p=0.026), and IVH (52% vs. 17%, p=0.043). Groups did not differ in terms of edema volume, amount of midline shift, evidence of hydrocephalus, or herniation. ICH volume to edema volume ratio was a better discriminator of poor outcome (AUC=0.813, p=0.006) than ICH volume (AUC=0.802, p=0.008, Figure 1a). Further, ICH volume to edema volume ratio was a better discriminator of poor outcome (AUC=0.801, p=0.009) than ICH score (AUC=0.724, p=0.051, Figure 1b). Discussion: Among young patients with non-lobar primary ICH we observed that the ICH to edema ratio was a better predictor of poor functional status at discharge than ICH volume or ICH score.

scholarly journals Machine Learning-Based Approaches for Prediction of Patients’ Functional Outcome and Mortality after Spontaneous Intracerebral Hemorrhage

2022 ◽  
Vol 12 (1) ◽  
pp. 112
Author(s):  
Rui Guo ◽  
Renjie Zhang ◽  
Ran Liu ◽  
Yi Liu ◽  
Hao Li ◽  
...  
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Laboratory Data ◽  
Predictive Performance ◽  
High Morbidity ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Receiver Operating Characteristic Curves ◽  
Ich Score

Spontaneous intracerebral hemorrhage (SICH) has been common in China with high morbidity and mortality rates. This study aims to develop a machine learning (ML)-based predictive model for the 90-day evaluation after SICH. We retrospectively reviewed 751 patients with SICH diagnosis and analyzed clinical, radiographic, and laboratory data. A modified Rankin scale (mRS) of 0–2 was defined as a favorable functional outcome, while an mRS of 3–6 was defined as an unfavorable functional outcome. We evaluated 90-day functional outcome and mortality to develop six ML-based predictive models and compared their efficacy with a traditional risk stratification scale, the intracerebral hemorrhage (ICH) score. The predictive performance was evaluated by the areas under the receiver operating characteristic curves (AUC). A total of 553 patients (73.6%) reached the functional outcome at the 3rd month, with the 90-day mortality rate of 10.2%. Logistic regression (LR) and logistic regression CV (LRCV) showed the best predictive performance for functional outcome (AUC = 0.890 and 0.887, respectively), and category boosting presented the best predictive performance for the mortality (AUC = 0.841). Therefore, ML might be of potential assistance in the prediction of the prognosis of SICH.

Abstract 215: Does the CT Angiography Spot Sign Identify Intracerebral Hemorrhage Patients More Likely to Benefit From Intensive Blood Pressure Reduction?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Andrea Morotti ◽  
Bart H Brouwers ◽  
Javier M Romero ◽  
Michael J Jessel ◽  
Anastasia Vashkevich ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Strong Predictor ◽  
Blood Pressure Reduction ◽  
Standard Group ◽  
Inclusion Criteria ◽  
Multivariable Logistic Regression Model ◽  
Spot Sign ◽  
Intensive Blood Pressure

Background and Purpose: the computed tomography angiography (CTA) spot sign is a strong predictor of intracerebral hemorrhage (ICH) expansion, and may mark those most likely to benefit from intensive blood pressure (BP) reduction. The Spot Sign score in restricting ICH growth (SCORE-IT) study analyzed whether intensive BP reduction improved outcome in Spot Sign positive patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) clinical trial. Methods: In ATACH-2, patients with ICH were randomly assigned to intensive (systolic BP target: 110-139 mmHg) versus standard (systolic BP target: 140-179 mmHg) BP treatment within 4.5 h from stroke onset. This analysis included patients with a CTA performed within 8 hours from onset. The association between intensive BP lowering, ICH expansion and functional outcome was investigated with a multivariable logistic regression model. Results: 133 subjects met the inclusion criteria, of whom 53 (39.9%) had a spot sign and 24/123 (19.5%) experienced ICH expansion. A total of 56/123 patients had a 90 day modified Rankin scale (mRS) >3 (45.5%). Among Spot positive patients, 74.1% of those in the intensive BP lowering group had poor outcome, compared with 50.0% of those in the standard group (p=0.31). After adjustment for potential confounders, intensive BP lowering was not associated with a significant reduction of ICH expansion (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.27 - 2.51, p = 0.74) or improved functional outcome (OR for mRS>3 1.24, 95% CI 0.53 - 2.91, p = 0.62) in spot sign positive ICH patients. Conclusions: We found no evidence that ICH patients with a spot sign specifically benefit from intensive BP reduction.

Abstract W P259: ICH &FUNC Scores in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kevin N Sheth ◽  
Gene Sung ◽  
Carl D Langefeld ◽  
Charles J Moomaw ◽  
Jennifer Osborne ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Rank Correlation ◽  
Predictive Ability ◽  
Spearman’S Rank Correlation ◽  
Hispanic Patients ◽  
Chart Abstraction ◽  
Ich Score ◽  
Hispanic White

Introduction: The Intracerebral Hemorrhage (ICH) Score and Functional Outcome (FUNC) Score are prediction scales used to estimate outcome. These scales have not yet been validated in large minority cohorts. Our goal was to evaluate the predictive ability of the ICH and FUNC Score for white, black, and Hispanic patients. Methods: ERICH is an ongoing study of genetic and environmental risk factors for spontaneous ICH. The analysis included 847 cases enrolled prior to 1/1/2013 that had chart abstraction, baseline interview, CT imaging, GCS, and 3-month follow-up data available. Spearman’s rank correlation was used to assess the correlation between each score and 3-month modified Rankin Scale (mRS) score by ethnicity. Regression models were used to determine the predictive ability of each score. Results: Patients analyzed were 42% non-Hispanic black, 34% Hispanic, and 24% non-Hispanic white. Black and Hispanic subjects were younger compared with white subjects (p<.0001) and had higher proportions of deep ICH (p=.0013). Spearman’s rank correlations for ICH Score/FUNC Score and mRS at 3 months post ICH were 0.53/0.53 for black subjects, 0.66/0.63 for Hispanics, and 0.55/0.54 for whites. Both ICH and FUNC Scores had better predictive ability for minorities compared with whites (ICH Score, B = 0.87 black, 1.02 Hispanic, 0.76 white, p<.0001; FUNC Score, B = 0.56 black, 0.65 Hispanic, 0.49 white, p<.0001). Multiple regression demonstrated independent contributions by both scores for each ethnicity. Figure 1 demonstrates distribution of mortality by score. Conclusions: Both the ICH Score and FUNC Score were independently predictive of functional outcome at 3 months. Importantly, each score exhibits higher predictive ability in minority populations compared with whites. Whether or not this difference is attributed to minority status or baseline differences in age or ICH location requires further study.

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

Stroke ◽  
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.

scholarly journals Determining ICH Score: can we go beyond?

2009 ◽  
Vol 67 (3a) ◽  
pp. 605-608 ◽  
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.

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

2017 ◽  
Vol 381 ◽  
pp. 182-187 ◽  
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

scholarly journals Imaging-Based Outcome Prediction of Acute Intracerebral Hemorrhage

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.

scholarly journals Association of axial length with retinal thickness and choroidal thickness in diabetic patients

2020 ◽  
Author(s):  
Sen Liu ◽  
Lanhua Wang ◽  
Wei Wang ◽  
Xia Gong ◽  
Yuting Li ◽  
...  
Keyword(s):  
Linear Regression ◽  
Axial Length ◽  
Regression Models ◽  
Choroidal Thickness ◽  
Retinal Thickness ◽  
Outer Ring ◽  
Protective Mechanism ◽  
Diabetic Patients ◽  
Macular Area ◽  
Linear Regression Models

AbstractBackgroundUnderstanding the associations of axial length (AL) with retinal thickness (RT) and choroidal thickness (CT) at different subgrids among diabetic participants are of great important in exploring potential protective mechanism and pathogenesis of diabetic retinopathy (DR) in myopic eyes. Therefore, this study aimed to investigate the associations of AL with RT and CT among participants with type-2 diabetes mellitus (T2DM).MethodsParticipants with T2DM and registered with the government-monitored diabetes communities near Zhongshan Ophthalmic Center, Guangzhou, China, were consecutively invited to participate in the current study from October 2017 to April 2019. High-definition retina and choroid images of the macular area were obtained using swept-source optical coherence tomography.AL and other ocular biometrics were measured using Lenstar900. Linear regression models were used to assess relationships between AL and RT as well as CT.ResultsA total of 1378 participants with a mean age of 63.8±7.75 years and mean AL of 23.6±1.15 mm were included in the current study. In the multivariate linear regression models, AL was positively associated with the central RT (β=4.11 per mm increased in AL, 95%confidence interval (CI)=2.66 to 5.56, P<0.001), but negatively associated with the RT of the outer ring (β=-3.37 per mm increased in AL, 95%CI=-4.19 to -2.56, P<0.001).Longer AL tended to have thinker CTs in the central (β=-27.4 per mm increased in AL, 95%CI=-31.2 to -23.7, P<0.001),outer ring (β=-20.8 per mm increased in AL, 95%CI=-23.8 to -17.7, P<0.001) and inner ring (β=-24.6 per mm increased in AL, 95%CI=-28.1 to -21.1, P<0.001).ConclusionsMyopic ocular elongation is accompanied by retinal thinning of the outer ring and retinal thickening of the foveal area. The CT of the macular area tended to become thinner with elongated AL among the diabetic subjects.

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