scholarly journals The coronal plane maximum diameter of deep intracerebral hemorrhage predicts functional outcome more accurately than hematoma volume

2021 ◽  
pp. 174749302110507
Author(s):  
Stefan P Haider ◽  
Adnan I Qureshi ◽  
Abhi Jain ◽  
Hishan Tharmaseelan ◽  
Elisa R Berson ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Characteristic Curve ◽  
Scoring Systems ◽  
Coronal Plane ◽  
Maximum Diameter ◽  
Shape Features ◽  
Hematoma Volume ◽  
Eligibility Criteria ◽  
Potential Biomarker

Background Among prognostic imaging variables, the hematoma volume on admission computed tomography (CT) has long been considered the strongest predictor of outcome and mortality in intracerebral hemorrhage. Aims To examine whether different features of hematoma shape are associated with functional outcome in deep intracerebral hemorrhage. Methods We analyzed 790 patients from the ATACH-2 trial, and 14 shape features were quantified. We calculated Spearman’s Rho to assess the correlation between shape features and three-month modified Rankin scale (mRS) score, and the area under the receiver operating characteristic curve (AUC) to quantify the association between shape features and poor outcome defined as mRS>2 as well as mRS > 3. Results Among 14 shape features, the maximum intracerebral hemorrhage diameter in the coronal plane was the strongest predictor of functional outcome, with a maximum coronal diameter >∼3.5 cm indicating higher three-month mRS scores. The maximum coronal diameter versus hematoma volume yielded a Rho of 0.40 versus 0.35 ( p = 0.006), an AUC[mRS>2] of 0.71 versus 0.68 ( p = 0.004), and an AUC[mRS>3] of 0.71 versus 0.69 ( p = 0.029). In multiple regression analysis adjusted for known outcome predictors, the maximum coronal diameter was independently associated with three-month mRS (p < 0.001). Conclusions A coronal-plane maximum diameter measurement offers greater prognostic value in deep intracerebral hemorrhage than hematoma volume. This simple shape metric may expedite assessment of admission head CTs, offer a potential biomarker for hematoma size eligibility criteria in clinical trials, and may substitute volume in prognostic intracerebral hemorrhage scoring systems.

Abstract T MP65: Rate of Peri-Hematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage

Stroke ◽  
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.

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

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.

scholarly journals Increased glycemic variability associated with a poor 30-day functional outcome in acute intracerebral hemorrhage

2018 ◽  
Vol 129 (4) ◽  
pp. 861-869 ◽  
Author(s):  
Yan-Chun Wu ◽  
Zan Ding ◽  
Jiang Wu ◽  
Yuan-Yuan Wang ◽  
Sheng-Chao Zhang ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Poor Prognosis ◽  
Characteristic Curve ◽  
Fasting Blood Glucose ◽  
Glycemic Variability ◽  
Acute Onset ◽  
Stress Hyperglycemia ◽  
Poor Outcome ◽  
Normal Glucose

OBJECTIVEIntracerebral hemorrhage (ICH) is associated with a poor prognosis and high mortality, but no study has elucidated the association between glycemic variability (GV) and functional outcome in ICH. The authors of this study aimed to determine whether GV is a predictor of 30-day functional outcome in ICH patients.METHODSThe study recruited 366 patients with first-ever acute-onset ICH in the period during 2014 and 2015. Fasting blood glucose was assessed on admission and with 7-day continuous monitoring. Glycemic variability was calculated and expressed by the standard deviation (GluSD) and coefficient of variation (GluCV). Patients were divided into groups of those with diabetes mellitus (DM), stress hyperglycemia (SHG), and normal glucose (NG). Functional outcome was measured using the modified Rankin Scale.RESULTSThe numbers of patients with DM, SHG, and NG were 108 (29.5%), 127 (34.7%), and 131 (35.8%), respectively. As compared with the DM patients, those with SHG had higher mortality (29.9% vs 15.7%, p < 0.05) and a poorer prognosis (64.6% vs 52.8%, p < 0.05). Poor prognosis was associated with both high GluSD (OR 1.54, 95% CI 1.19–1.99) and high GluCV (1.05, 1.02–1.09), especially in the DM group. The area under the receiver operating characteristic curve was greater for the GluSD (OR 0.929, 95% CI 0.902–0.956) and the GluCV (0.932, 0.906–0.958) model than the original model (0.860, 0.823–0.898) in predicting a poor outcome.CONCLUSIONSStress hyperglycemia may be associated with increased mortality and a poor outcome in ICH, and increased GV may be independently associated with a poor outcome, particularly in ICH patients with DM.

scholarly journals Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage

Neurology ◽  
2021 ◽  
Vol 96 (15) ◽  
pp. e1954-e1965
Author(s):  
Isabel C. Hostettler ◽  
Ghil Schwarz ◽  
Gareth Ambler ◽  
Duncan Wilson ◽  
Gargi Banerjee ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Small Vessel Disease ◽  
Characteristic Curve ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Cortical Atrophy ◽  
Vessel Disease ◽  
Lemeshow Test ◽  
Ich Score

ObjectiveTo determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH) and whether these biomarkers improve the performance of the preexisting ICH prediction score.MethodsWe included 864 patients with acute ICH from a multicenter, hospital-based prospective cohort study. We evaluated CT-based SVD biomarkers (white matter hypodensities [WMH], lacunes, brain atrophy, and a composite SVD burden score) and their associations with poor 6-month functional outcome (modified Rankin Scale score >2). The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow test were used to assess discrimination and calibration of the ICH score with and without SVD biomarkers.ResultsIn multivariable models (adjusted for ICH score components), WMH presence (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.12–2.06), cortical atrophy presence (OR 1.80, 95% CI 1.19–2.73), deep atrophy presence (OR 1.66, 95% CI 1.17–2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95% CI 1.36–2.74) were independently associated with poor functional outcome. For the revised ICH score, the AUROC was 0.71 (95% CI 0.68–0.74). Adding SVD markers did not significantly improve ICH score discrimination; for the best model (adding severe atrophy), the AUROC was 0.73 (95% CI 0.69–0.76). These results were confirmed when lobar and nonlobar ICH were considered separately.ConclusionsThe ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome, but adding them does not significantly improve ICH score discrimination.Trial Registration InformationClinicalTrials.gov Identifier: NCT02513316.

scholarly journals Early Predictors of the Increase in Perihematomal Edema Volume After Intracerebral Hemorrhage: A Retrospective Analysis From the Risa-MIS-ICH Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Gengzhao Ye ◽  
Shuna Huang ◽  
Renlong Chen ◽  
Yan Zheng ◽  
Wei Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Hematoma Expansion ◽  
Hematoma Volume ◽  
Absolute Increase ◽  
Poor Outcome ◽  
Perihematomal Edema

Background and Purpose: Perihematomal edema (PHE) is associated with poor functional outcomes after intracerebral hemorrhage (ICH). Early identification of risk factors associated with PHE growth may allow for targeted therapeutic interventions.Methods: We used data contained in the risk stratification and minimally invasive surgery in acute intracerebral hemorrhage (Risa-MIS-ICH) patients: a prospective multicenter cohort study. Patients' clinical, laboratory, and radiological data within 24 h of admission were obtained from their medical records. The absolute increase in PHE volume from baseline to day 3 was defined as iPHE volume. Poor outcome was defined as modified Rankin Scale (mRS) of 4 to 6 at 90 days. Binary logistic regression was used to assess the relationship between iPHE volume and poor outcome. The receiver operating characteristic curve was used to find the best cutoff. Linear regression was used to identify variables associated with iPHE volume (ClinicalTrials.gov Identifier: NCT03862729).Results: One hundred ninety-seven patients were included in this study. iPHE volume was significantly associated with poor outcome [P = 0.003, odds ratio (OR) 1.049, 95% confidence interval (CI) 1.016–1.082] after adjustment for hematoma volume. The best cutoff point of iPHE volume was 7.98 mL with a specificity of 71.4% and a sensitivity of 47.5%. Diabetes mellitus (P = 0.043, β = 7.66 95% CI 0.26–15.07), black hole sign (P = 0.002, β = 18.93 95% CI 6.84–31.02), and initial ICH volume (P = 0.018, β = 0.20 95% CI 0.03–0.37) were significantly associated with iPHE volume. After adjusting for hematoma expansion, the black hole sign could still independently predict the increase of PHE (P &lt; 0.001, β = 21.62 95% CI 10.10–33.15).Conclusions: An increase of PHE volume &gt;7.98 mL from baseline to day 3 may lead to poor outcome. Patients with diabetes mellitus, black hole sign, and large initial hematoma volume result in more PHE growth, which should garner attention in the treatment.

scholarly journals IL-33 as a Novel Serum Prognostic Marker of Intracerebral Hemorrhage

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ye Miao ◽  
Zhen-xing Zhang ◽  
Xu Feng ◽  
Wei-ming Sun
Keyword(s):  
Intracerebral Hemorrhage ◽  
Poor Prognosis ◽  
Demographic Data ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Underlying Mechanism ◽  
Good Prognosis ◽  
Imaging Data ◽  
Hematoma Volume ◽  
Number Of Patients

Objective. Interleukin 33 (IL-33) is a key cytokine involved in inflammation and oxidative stress. The significance of serum IL-33 levels on the prognosis of patients with intracerebral hemorrhage (ICH) has not been well studied. The purpose of this study is to determine whether there is a relationship between the serum IL-33 level and the prognosis of patients with ICH upon admission. Methods. A total of 402 patients with confirmed ICH were included in this study. Their demographic data, medical history, laboratory data, imaging data, and clinical scores on admission were collected. At the same time, enzyme-linked immunoassay (ELISA) was used to detect the serum IL-33 levels of patients. The prognosis of patients was evaluated by mRS scale after 3 months, and mRS > 2 was defined as poor prognosis. Results. Among 402 patients with ICH, the number of patients with good prognosis and poor prognosis after 3 months was 148 and 254, respectively. Compared with the ICH group with poor prognosis, the ICH group with good prognosis had lower baseline NHISS scores ( p = 0.039 ) and hematoma volume ( p = 0.025 ) and higher GCS scores ( p < 0.001 ) and serum IL-33 levels ( p < 0.001 ). The results of linear correlation analysis showed that serum IL-33 levels were significantly negatively correlated with baseline NHISS scores ( r = − 0.224 , p = 0.033 ) and hematoma volume ( r = − 0.253 , p = 0.046 ) but were significantly positively correlated with baseline GCS scores ( r = 0.296 , p = 0.020 ). The receiver operating characteristic curve (ROC) analysis showed that the sensitivity and specificity of serum IL-33 level in evaluating the prognosis of ICH were 72.1% and 74.3%, respectively. A cut-off value of serum IL-33 level < 109.3  pg/mL may indicate a poor prognosis for ICH. Conclusions. Serum IL-33 level on admission may be a prognostic indicator of ICH, and its underlying mechanism needs further study.

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

2019 ◽  
Vol 15 (1) ◽  
pp. 90-102 ◽  
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.

Perihemorrhagic edema

Neurology ◽  
2019 ◽  
Vol 93 (12) ◽  
pp. e1159-e1170 ◽  
Author(s):  
Maximilian I. Sprügel ◽  
Joji B. Kuramatsu ◽  
Bastian Volbers ◽  
Stefan T. Gerner ◽  
Jochen A. Sembill ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Time Course ◽  
Multivariable Logistic Regression Analysis ◽  
Lesion Volume ◽  
Hematoma Volume ◽  
Edema Volume ◽  
Major Parameter ◽  
Perihemorrhagic Edema

ObjectiveTo determine the influence of intracerebral hemorrhage (ICH) location and volume and hematoma surface on perihemorrhagic edema evolution.MethodsPatients with ICH of the prospective Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage (UKER-ICH) cohort study (NCT03183167) between 2010 and 2013 were analyzed. Hematoma and edema volume during hospital stay were volumetrically assessed, and time course of edema evolution and peak edema correlated to hematoma volume, location, and surface to verify the strength of the parameters on edema evolution.ResultsOverall, 300 patients with supratentorial ICH were analyzed. Peak edema showed a high correlation with hematoma surface (R2 = 0.864, p < 0.001) rather than with hematoma volumes, regardless of hematoma location. Smaller hematomas with a higher ratio of hematoma surface to volume showed exponentially higher relative edema (R2 = 0.755, p < 0.001). Multivariable logistic regression analysis revealed a cutoff ICH volume of 30 mL, beyond which an increase of total mass lesion volume (combined volume of hematoma and edema) was not associated with worse functional outcome. Specifically, peak edema was associated with worse functional outcome in ICH <30 mL (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.68–4.12, p < 0.001), contrary to ICH ≥30 mL (OR 1.20, 95% CI 0.88–1.63, p = 0.247). There were no significant differences between patients with lobar and those with deep ICH after adjustment for hematoma volumes.ConclusionsPeak perihemorrhagic edema, although influencing mortality, is not associated with worse functional outcomes in ICH volumes >30 mL. Although hematoma volume correlates with peak edema extent, hematoma surface is the major parameter for edema evolution. The effect of edema on functional outcome is therefore more pronounced in smaller and irregularly shaped hematomas, and these patients may particularly benefit from edema-modifying therapies.

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