Abstract P423: Race and Ethnicity Influence Perihematomal Edema Volume in Supratentorial Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Julian N Acosta ◽  
Yasheng Chen ◽  
Cameron Both ◽  
Audrey C Leasure ◽  
Fernando Testai ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Race And Ethnicity ◽  
Learning Algorithm ◽  
Multivariable Analysis ◽  
Secondary Brain Injury ◽  
Racial Groups ◽  
Deep Learning Algorithm ◽  
Perihematomal Edema ◽  
Study Participants ◽  
Racial Ethnic

Introduction: Perihematomal Edema (PHE) is a neuroimaging biomarker of secondary brain injury in patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH). There are limited data on racial/ethnic differences in the development of PHE. This dearth of data is partially driven by the time-consuming process of manually segmenting PHE. Leveraging a validated automated pipeline for PHE segmentation, we evaluated whether race and ethnicity influence baseline PHE volume in patients with ICH. Methods: The Ethnic/Racial Variations in Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter study of ICH that recruited 1,000 adult participants from each of three racial/ethnic groups (non-Hispanic White, non-Hispanic Black, and Hispanic). We applied a previously validated deep learning algorithm to automatically determine PHE volumes on baseline CTs in these study participants. Quality control procedures were used to include only sufficiently accurate PHE measurements. Linear regression was used to identify factors associated with log-transformed PHE volume and to identify differences across Ethnic/Racial groups. Results: Our imaging pipeline provided good quality baseline PHE measurements on 2,008 out of 3,000 ERICH study participants. After excluding infratentorial hemorrhages (273) and those with missing or null baseline ICH volume (49), 1,686 remained for analysis (median age 59 [IQR 51-71], 687 [41%] female sex). Median PHE volume was 12.0 (IQR 4.8-27.1) for whites, 11.9 (IQR 4.5-26.1) for Hispanics and 8.3 (IQR 3.0-19.2) for blacks. Compared to Blacks, Hispanics (beta 0.22; 95%CI 0.11-0.32; p<0.001) and Whites (beta 0.20; 95%CI 0.07-0.33; p=0.003) had higher baseline PHE volumes, in multivariable analysis adjusting for age, sex, ICH location, log-baseline ICH volume, log-baseline intraventricular volume, and systolic blood pressure on admission. Conclusion: Race and ethnicity influence the volume of baseline PHE. Further studies are needed to validate our results and investigate the biological underpinnings of this difference.

scholarly journals Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence

Neurology ◽  
2019 ◽  
Vol 94 (3) ◽  
pp. e314-e322 ◽  
Author(s):  
Audrey C. Leasure ◽  
Zachary A. King ◽  
Victor Torres-Lopez ◽  
Santosh B. Murthy ◽  
Hooman Kamel ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ethnic Groups ◽  
Proportional Hazards ◽  
Private Insurance ◽  
Multivariable Analysis ◽  
Ethnic Disparities ◽  
Cox Proportional Hazards ◽  
Risk Of Recurrence ◽  
Asian Patients ◽  
Racial Ethnic

ObjectiveTo estimate the risk of intracerebral hemorrhage (ICH) recurrence in a large, diverse, US-based population and to identify racial/ethnic and socioeconomic subgroups at higher risk.MethodsWe performed a longitudinal analysis of prospectively collected claims data from all hospitalizations in nonfederal California hospitals between 2005 and 2011. We used validated diagnosis codes to identify nontraumatic ICH and our primary outcome of recurrent ICH. California residents who survived to discharge were included. We used log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with risk of recurrence after adjusting for potential confounders.ResultsWe identified 31,355 California residents with first-recorded ICH who survived to discharge, of whom 15,548 (50%) were white, 6,174 (20%) were Hispanic, 4,205 (14%) were Asian, and 2,772 (9%) were black. There were 1,330 recurrences (4.1%) over a median follow-up of 2.9 years (interquartile range 3.8). The 1-year recurrence rate was 3.0% (95% confidence interval [CI] 2.8%–3.2%). In multivariable analysis, black participants (hazard ratio [HR] 1.22; 95% CI 1.01–1.48; p = 0.04) and Asian participants (HR 1.29; 95% CI 1.10–1.50; p = 0.001) had a higher risk of recurrence than white participants. Private insurance was associated with a significant reduction in risk compared to patients with Medicare (HR 0.60; 95% CI 0.50–0.73; p < 0.001), with consistent estimates across racial/ethnic groups.ConclusionsBlack and Asian patients had a higher risk of ICH recurrence than white patients, whereas private insurance was associated with reduced risk compared to those with Medicare. Further research is needed to determine the drivers of these disparities.

scholarly journals Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression

2016 ◽  
Vol 37 (5) ◽  
pp. 1871-1882 ◽  
Author(s):  
Raimund Helbok ◽  
Alois Josef Schiefecker ◽  
Christian Friberg ◽  
Ronny Beer ◽  
Mario Kofler ◽  
...  
Keyword(s):  
Brain Injury ◽  
Intracerebral Hemorrhage ◽  
Electrode Placement ◽  
Secondary Brain Injury ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Strip Electrode ◽  
Hematoma Evacuation ◽  
Perihematomal Edema ◽  
Pathophysiologic Mechanisms

Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3–5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9–22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.

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

Stroke ◽  
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.

Abstract WP309: Association of Molecular Markers with Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Na Li ◽  
Yan Fang Liu ◽  
Li Ma ◽  
Hans Worthmann ◽  
Peter Raab ◽  
...  
Keyword(s):  
Molecular Markers ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Neuronal Cell Death ◽  
Neuronal Cell ◽  
Stroke Severity ◽  
Secondary Brain Injury ◽  
Hematoma Volume ◽  
Perihematomal Edema

Background and Purpose: Perihematomal edema (PHE) contributes to secondary brain injury in intracerebral hemorrhage (ICH). Increase of matrix metalloproteinases (MMPs) and growth factors (GFs) is considerably involved in blood-brain barrier disruption and neuronal cell death in ICH models. We therefore hypothesized that increased levels of these molecular markers are associated with PHE and clinical outcome in ICH patients. Methods: Fifty-nine patients with spontaneous ICH admitted within 24 hours of symptom onset were prospectively investigated. Noncontrast CT was performed on admission for diagnosis of ICH and quantification of initial hematoma volume. MRI was performed on day 3 in order to evaluate PHE. Concentrations of MMP-3, MMP-9, as well as vascular endothelial growth factor (VEGF) and Angiopoietin-1(Ang-1) on admission were determined by enzyme-linked immunosorbent assays. Clinical outcome was assessed by modified Rankin Scale (mRS) at 90days. Results: Increased MMP-3 levels were independently associated with PHE volume (P<0.05). Cytotoxic edema (CE) surrounding the hematoma was seen in 36 (61%) cases on 3-day MRI. CE did not correlate with the level of any of the biomarkers studied. Levels of MMP-3 ≥12.4 ng/ml and MMP-9 ≥192.4 ng/ml but not VEGF and Ang-1 predicted poor clinical outcome at 90 days (mRS>3) independent of stroke severity and hematoma volume at baseline (OR 25.3, P=0.035; OR 68.9, P=0.023; respectively). Conclusion: Metalloproteinases 3 and 9 seem to be significantly involved in secondary brain injury and outcome after primary ICH in humans and thus should be further evaluated as targets for therapeutic strategies in this devastating disorder.

Abstract P454: Do Not Resuscitate Orders in Intracerebral Hemorrhage Patients. Impact on Mortality

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf A Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
The Self ◽  
Racial Groups ◽  
Do Not Resuscitate ◽  
Code Status ◽  
International Classification Of Disease ◽  
Discharge Outcomes ◽  
Racial Ethnic ◽  
Dnr Orders

Introduction/background: Do not resuscitate (DNR) orders have been associated with higher mortality in hospitalized patients which the question if they these patients are victims of the self-fulfilling prophecy; that the odds of their survival is made worse by withholding aggressive treatment. In addition, previous reports show that racial and ethnic minorities tend to opt for more aggressive and lifesaving procedures as compared to Whites. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. DNR code status was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, length of stay) were compared between the two groups. DNR code status was compared between different racial groups. Results: Of the 884379 patients with ICH, 81968 (9.26%%) had DNR order. ICH patients with DNR order had higher proportion of females (55.1% versus 49.1%, P <.0001) and were older (74.2 years versus 66 years, P <.0001) compared to ICH patients without DNR. The in-hospital mortality was also higher (53.4% versus 23.3%, p≤.0001) among patients with DNR both univariate and multivariate analysis (OR = 3.24 (3.07 -3.41), p<.0001) after adjusting for potential confounders. Whites have a higher rate (11.5% versus 8.08%) of DNR order as compared to other racial/ethnic groups Conclusions: While there may be other explanations at play, the higher mortality and shorter LOS suggest that early DNR orders do lead to the self-fulfilling prophecy. The lower proportion of DNR orders among minorities suggest a sociocultural aspect in accepting the concept of DNR. These two facts raise concerns about what the real vs perceived meaning of DNR orders.

scholarly journals COVID-19 Vaccine Acceptance and Beliefs among Black and Hispanic Americans

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256122
Author(s):  
Katherine Kricorian ◽  
Karin Turner
Keyword(s):  
Race And Ethnicity ◽  
Hispanic Americans ◽  
Vaccine Hesitancy ◽  
Vaccine Acceptance ◽  
Time Period ◽  
Survey Results ◽  
Tailored Communications ◽  
Study Participants ◽  
To Receive ◽  
Racial Ethnic

The introduction of COVID-19 vaccines is a major public health breakthrough. However, members of US Black and Hispanic communities, already disproportionately affected by the COVID-19 virus, may be less willing to receive the vaccine. We conducted a broad, representative survey of US adults (N = 1,950) in order to better understand vaccine beliefs and explore opportunities to increase vaccine acceptance among these groups. The survey results suggested that Black and Hispanic individuals were less willing than Whites to receive the vaccine. US Blacks and Hispanics also planned to delay receiving the COVID-19 vaccine for a longer time period than Whites, potentially further increasing the risk of contracting COVID-19 within populations that are already experiencing high disease prevalence. Black respondents were less likely to want the COVID-19 vaccine at all compared with Whites and Hispanics, and mistrust of the vaccine among Black respondents was significantly higher than other racial/ethnic groups. Encouragingly, many Black and Hispanic respondents reported that COVID-19 vaccine endorsements from same-race medical professionals would increase their willingness to receive it. These respondents said they would also be motivated by receiving more information on the experiences of vaccine study participants who are of their own race and ethnicity. The results have implications for improved messaging of culturally-tailored communications to help reduce COVID-19 vaccine hesitancy among communities disproportionately impacted by the pandemic.

scholarly journals Perihematomal Edema After Intracerebral Hemorrhage: An Update on Pathogenesis, Risk Factors, and Therapeutic Advances

2021 ◽  
Vol 12 ◽  
Author(s):  
Yihao Chen ◽  
Shengpan Chen ◽  
Jianbo Chang ◽  
Junji Wei ◽  
Ming Feng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Mass Effect ◽  
Underlying Mechanism ◽  
Secondary Brain Injury ◽  
Surgical Measures ◽  
Promising Therapeutic Target ◽  
Potential Impact ◽  
Perihematomal Edema ◽  
Preclinical And Clinical Studies

Intracerebral hemorrhage (ICH) has one of the worst prognoses among patients with stroke. Surgical measures have been adopted to relieve the mass effect of the hematoma, and developing targeted therapy against secondary brain injury (SBI) after ICH is equally essential. Numerous preclinical and clinical studies have demonstrated that perihematomal edema (PHE) is a quantifiable marker of SBI after ICH and is associated with a poor prognosis. Thus, PHE has been considered a promising therapeutic target for ICH. However, the findings derived from existing studies on PHE are disparate and unclear. Therefore, it is necessary to classify, compare, and summarize the existing studies on PHE. In this review, we describe the growth characteristics and relevant underlying mechanism of PHE, analyze the contributions of different risk factors to PHE, present the potential impact of PHE on patient outcomes, and discuss the currently available therapeutic strategies.

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