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

Stroke ◽  
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.

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

Stroke ◽  
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.

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.

scholarly journals Regional differences in the response to acute blood pressure lowering after cerebral hemorrhage

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011229
Author(s):  
Kazunori Toyoda ◽  
Yuko Y Palesch ◽  
Masatoshi Koga ◽  
Lydia Foster ◽  
Haruko Yamamoto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Intracerebral Hemorrhage ◽  
East Asia ◽  
Functional Outcomes ◽  
Intensive Treatment ◽  
Hematoma Expansion ◽  
Blood Pressure Lowering ◽  
Pressure Lowering ◽  
Intensive Blood Pressure

Objective:To compare the impact of intensive blood pressure (BP) lowering right after intracerebral hemorrhage (ICH) on clinical and hematoma outcomes among patients from different geographic locations, we performed a prespecified sub-analysis of the randomized, multi-national, two-group, open-label trial to determine the efficacy of rapidly lowering BP in hyperacute ICH (ATACH-2), involving 537 patients from East Asia and 463 recruited outside of Asia.Methods:Eligible patients were randomly assigned to a systolic BP (SBP) target of 110-139 mmHg (intensive treatment) or 140-179 mmHg (standard treatment). Pre-defined outcomes were: poor functional outcome (modified Rankin Scale score of 4-6 at 90 days), death within 90 days, hematoma expansion at 24 hours; and cardio-renal adverse events within 7 days.Results:Poor functional outcomes (32.0% versus 45.9%), death (1.9% versus 13.3%), and cardio-renal adverse events (3.9% versus 11.2%) occurred significantly less in patients from Asia than those outside of Asia. The treatment-by-cohort interaction was not significant for any outcomes. Only patients from Asia showed a lower incidence of hematoma expansion with intensive treatment (adjusted RR 0.56, 95% CI 0.38-0.83). Both Asian (3.53, 1.28-9.64) and non-Asian cohorts (1.71, 1.00-2.93) showed a higher incidence of cardio-renal adverse events with intensive treatment.Conclusions:Poor functional outcomes and death 90 days after ICH were less common in patients from East Asia than those outside of Asia. Hematoma expansion, a potential predictor for poor clinical outcome, was attenuated by intensive BP lowering only in the Asian cohort.Clinicaltrials.gov identifierNCT01176565.Classification of evidence:This study provides Class II evidence that, for patients from East Asia with intracerebral hemorrhage, intensive blood pressure lowering significantly reduces the risk of hematoma expansion.

scholarly journals Iodine Sign as a Novel Predictor of Hematoma Expansion and Poor Outcomes in Primary Intracerebral Hemorrhage Patients

Stroke ◽  
2018 ◽  
Vol 49 (9) ◽  
pp. 2074-2080 ◽  
Author(s):  
Fan Fu ◽  
Shengjun Sun ◽  
Liping Liu ◽  
Hongqiu Gu ◽  
Yaping Su ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hematoma Expansion ◽  
Poor Outcomes

scholarly journals Restarting antiplatelet therapy after spontaneous intracerebral hemorrhage

Neurology ◽  
2018 ◽  
Vol 91 (1) ◽  
pp. e26-e36 ◽  
Author(s):  
Ching-Jen Chen ◽  
Dale Ding ◽  
Thomas J. Buell ◽  
Fernando D. Testai ◽  
Sebastian Koch ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Primary Outcome ◽  
Modified Rankin Scale ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Secondary Outcomes

ObjectiveTo compare the functional outcomes and health-related quality of life metrics of restarting vs not restarting antiplatelet therapy (APT) in patients presenting with intracerebral hemorrhage (ICH) in the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study.MethodsAdult patients aged 18 years and older who were on APT before ICH and were alive at hospital discharge were included. Patients were dichotomized based on whether or not APT was restarted after hospital discharge. The primary outcome was a modified Rankin Scale score of 0–2 at 90 days. Secondary outcomes were excellent outcome (modified Rankin Scale score 0–1), mortality, Barthel Index, and health status (EuroQol–5 dimensions [EQ-5D] and EQ-5D visual analog scale scores) at 90 days.ResultsThe APT and no APT cohorts comprised 127 and 732 patients, respectively. Restarting APT was associated with lower rates of good functional outcome (36.5% vs 40.8%; p = 0.021) and lower Barthel Index scores at 90 days (p = 0.041). The 2 cohorts were then matched in a 1:1 ratio, and the matched cohorts each comprised 107 patients. No difference in primary outcome was observed between restarting vs not restarting APT (35.5% vs 43.9%; p = 0.105). There were also no differences between the secondary outcomes of the 2 cohorts.ConclusionRestarting APT in patients with ICH of mild to moderate severity after acute hospitalization is not associated with worse functional outcomes or health-related quality of life at 90 days. In patients with significant cardiovascular risk factors who experience an ICH, restarting APT remains the decision of the treating practitioner.

Lactate Dehydrogenase Predicts Early Hematoma Expansion and Poor Outcomes in Intracerebral Hemorrhage Patients

2019 ◽  
Vol 10 (6) ◽  
pp. 620-629 ◽  
Author(s):  
Heling Chu ◽  
Chuyi Huang ◽  
Jing Dong ◽  
Xiaobo Yang ◽  
Jun Xiang ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Intracerebral Hemorrhage ◽  
Hematoma Expansion ◽  
Poor Outcomes

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

2017 ◽  
Vol 5 (2) ◽  
pp. e428 ◽  
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.

scholarly journals Hematoma expansion is more frequent in deep than lobar intracerebral hemorrhage

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3386-e3393
Author(s):  
David Roh ◽  
Amelia Boehme ◽  
Codi Young ◽  
William Roth ◽  
Jose Gutierrez ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Confidence Intervals ◽  
Symptom Onset ◽  
Subgroup Analysis ◽  
Intraventricular Hemorrhage ◽  
Hematoma Expansion ◽  
Relative Growth ◽  
Racial Variations ◽  
Poor Outcomes

ObjectiveTo test the hypothesis that patients with deep intracerebral hemorrhage (ICH) would encounter hematoma expansion (HE) more frequently compared to patients with lobar ICH.MethodsPatients with ICH with neuroimaging to calculate HE were analyzed from the multicenter Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) cohort. Patients with laboratory coagulopathy or preceding anticoagulant use were excluded to assess relationships of ICH location alone (deep vs lobar) with HE, defined as >33% relative growth. Odds ratios (ORs) and 95% confidence intervals (CIs) for these relationships were estimated with logistic regression. Sensitivity and specificity determined HE thresholds best associated with poor 3-month outcomes (modified Rankin score 4-6) stratified by location.ResultsThere were 1,049 patients with deep and 408 patients with lobar ICH analyzed. Deep ICH locations were more likely to have HE (adjusted OR 1.57, 95% CI 1.08–2.29) after adjustment for age, sex, race, baseline hematoma size, and intraventricular hemorrhage. However, this difference was nonsignificant (adjusted OR 1.35, 95% CI 0.81–2.24) after controlling for time from symptom onset to admission CT in a subgroup analysis of 729 patients with these data. Yet, the threshold of HE best associated with poor outcomes was smaller in deep (30%) compared to lobar (50%) ICH.ConclusionsWhile HE was more frequent in deep than lobar ICH, this could be due to differences in symptom onset to admission CT times in our cohort. However, patients with deep ICH appear particularly vulnerable to the deleterious effects of small volumes of HE. Further studies should clarify whether ICH location needs to be considered in HE treatment paradigms.

scholarly journals Early chemoprophylaxis for deep venous thrombosis does not increase the risk of hematoma expansion in patients presenting with spontaneous intracerebral hemorrhage

2021 ◽  
Vol 12 ◽  
pp. 277
Author(s):  
Dimitri Laurent ◽  
Olgert Bardhi ◽  
Paul Kubilis ◽  
Brian Corliss ◽  
Stephanie Adamczak ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Hematoma Expansion ◽  
Optimal Timing ◽  
Thromboembolic Events ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Background: Spontaneous intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. The development of venous thromboembolism (VTE), including deep venous thrombosis or pulmonary embolism, is correlated with negative outcomes following ICH. Due to the risk of hematoma expansion associated with the use of VTE chemoprophylaxis, there remains significant debate about the optimal timing for its initiation following ICH. We analyzed the risk of early chemoprophylaxis on hematoma expansion following ICH. Methods: We performed a retrospective analysis of patients presenting with spontaneous ICH at single institution between 2011 and 2018. The rate of hematoma expansion was compared between patients that received early chemoprophylaxis (on admission) and those that received conventional chemoprophylaxis (>24 h). Results: Data for 235 patients were available for analysis. Eleven patients (7.5%) in the early prophylaxis cohort and seven patients (8.0%) in the conventional prophylaxis cohort developed VTE (P = 0.9). Hematoma expansion also did not differ significantly (early 19%, conventional 23%, P = 0.5). Conclusion: The use of early chemoprophylaxis against venous thromboembolic events following ICH appears safe in our patient population without increasing the risk of hematoma expansion. Given the increased risk of poor outcome in the setting of VTE, early VTE chemoprophylaxis should be considered in patients who present with ICH. Larger, prospective, and randomized studies are necessary to better elucidate the risk of early chemoprophylaxis and potential reduction in venous thromboembolic events.

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