Severity assessment in maximally treated ICH patients

Objective:As common prognostication models in intracerebral hemorrhage (ICH) are developed variably including patients with early (<24 hours) care limitations (ECL), we investigated its interaction with prognostication in maximally treated patients and sought to provide a new unbiased severity assessment tool.Methods:This observational cohort study analyzed consecutive ICH patients (n = 583) from a prospective registry over 5 years. We characterized the influence of ECL on overall outcome by propensity score matching and on conventional prognostication using receiver operating characteristic analyses. We established the max-ICH score based on independent predictors of 12-month functional outcome in maximally treated patients and compared it to existing models.Results:Prevalence of ECL was 19.2% (n = 112/583) and all of these patients died. Yet propensity score matching displayed that 50.7% (n = 35/69) theoretically could have survived, with 18.8% (n = 13/69) possibly reaching favorable outcome (modified Rankin Scale score 0–3). Conventional prognostication seemed to be confounded by ECL, documented by a decreased predictive validity (area under the curve [AUC] 0.67, confidence interval [CI] 0.61–0.73 vs AUC 0.80, CI 0.76–0.83; p < 0.01), overestimating poor outcome (mortality by 44.8%, unfavorable outcome by 10.1%) in maximally treated patients. In these patients, the novel max-ICH score (0–10) integrates strength-adjusted predictors, i.e., NIH Stroke Scale score, age, intraventricular hemorrhage, anticoagulation, and ICH volume (lobar and nonlobar), demonstrating improved predictive accuracy for functional outcome (12 months: AUC 0.81, CI 0.77–0.85; p < 0.01). The max-ICH score may more accurately delineate potentials of aggressive care, showing favorable outcome in 45.4% (n = 214/471) and a long-term mortality rate of only 30.1% (n = 142/471).Conclusions:Care limitations significantly influenced the validity of common prognostication models resulting in overestimation of poor outcome. The max-ICH score demonstrated increased predictive validity with minimized confounding by care limitations, making it a useful tool for severity assessment in ICH patients.

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Abstract 3305: Intensive Lipid-lowering and Early Functional Outcome in Acute Ischemic Stroke: Propensity Score Matching Analysis

Stroke ◽

10.1161/str.43.suppl_1.a3305 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Woo-Keun Seo ◽

Mi-Yeon Eun ◽

Ji Hyun Kim ◽

Kyungmi Oh ◽

Seong-Beom Koh

Keyword(s):

Ischemic Stroke ◽

Propensity Score ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Propensity Score Matching ◽

Favorable Outcome ◽

Lipid Lowering ◽

Stroke Patients ◽

Early Functional Outcome ◽

Significant Difference

Background This retrospective case-control study was designed to compare the effect of early high-dose atorvastatin treatment on early functional outcome in acute ischemic stroke patients using propensity score matching (PSM). Study design and population Acute ischemic stroke patients were selected from prospectively collected hospital-based stroke registry. Because the purpose of this study was comparing two treatment strategies for statin treatment, patients with cardioembolic stroke subtype or other-etiology were excluded. Patients were allocated into two groups: Intensive treatment group (atorvastatin 80mg; IT) and conventional treatment group (atorvastatin 10-40mg or other lipid-lowering agent; CT). All the patients were prescribed for aspirin 300mg at admission except for the patients who were considered for thrombolysis. After admission, the patients were prescribed for antithrombotics according to the clinical decision of the attending physician. All other practice guidelines except management of dyslipidemia were followed for previously published guidelines for management of stroke patients. Detailed demographic factors, vascular risk factors, laboratory parameters and vascular imaging were recorded. The end points were composed of two parameters. First, early neurological deterioration (END) defined as 4 points or more deterioration of National Institute of Health Stroke Score (NIHSS) from admission to the seventh hospital day. In case of discharge before the seventh hospital day, NIHSS at discharge was substituted for that of the seventh hospital day. Second, favorable outcome was defined as 0-2 of modified Rankin Score (mRS) measured at 3 months from the onset of stroke. Because baseline characteristics between the groups was supposed to be different, propensity score matching was performed to adjust for potential selection biases and confounding. A logistic regression model was fitted relating treatment strategies (IT and CT) to pretreatment patient characteristics. For the comparison between IT and CT in terms of END and favorable outcome, McNemar test were performed. Results: Among the study population, data of 178 patients for IT and 218 patients for CT were collected. Between the groups, history of previous stroke, TOAST classification, and previous medication of clopidogrel showed significant difference. There was no significant difference of 90-day favorable outcome and END. After PSM, 116 patients for each group were selected. There was no significant difference of baseline characteristics between the groups after PSM. There was no significant difference between IT and CT in terms of 90-day favorable outcome (75.3% in IT and 78.4% in CT, p = 0.457) and END (IT 72.3%, CT 78.6%, p = 0.097). Conclusion In this study, effect of intensive lipid-lowering treatment in acute stroke patients was negligible in terms of early functional outcome.

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Thrombocytopenia and Clinical Outcomes in Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.120.031478 ◽

2021 ◽

Vol 52 (2) ◽

pp. 611-619

Author(s):

Anne Mrochen ◽

Maximilian I. Sprügel ◽

Stefan T. Gerner ◽

Jochen A. Sembill ◽

Stefan Lang ◽

...

Keyword(s):

Platelet Count ◽

Propensity Score ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Scale Score ◽

Vitamin K ◽

Vitamin K Antagonist ◽

Modified Rankin Scale

Background and Purpose: The impact of platelets on hematoma enlargement (HE) of intracerebral hemorrhage (ICH) is not yet sufficiently elucidated. Especially the role of reduced platelet counts on HE and clinical outcomes is still poorly understood. This study investigated the influence of thrombocytopenia on HE, functional outcome, and mortality in patients with ICH with or without prior antiplatelet therapy (APT). Methods: Individual participant data of multicenter cohort studies (multicenter RETRACE program [German-Wide Multicenter Analysis of Oral Anticoagulation-Associated Intracerebral Hemorrhage] and single-center UKER-ICH registry [Universitätsklinikum Erlangen Cohort of Patients With Spontaneous ICH]) were grouped into APT and non-APT ICH patients according to the platelet count, that is, with or without thrombocytopenia (cells <150×10 9 /L). Of all patients, 51.5% (1124 of 2183) were on vitamin K antagonist. Imbalances in baseline characteristics including proportions of vitamin K antagonist patients were addressed using propensity score matching. Outcome analyses included HE (>33%), as well as mortality and functional outcome, after 3 months using the modified Rankin Scale, dichotomized into favorable (modified Rankin Scale score, 0–3) and unfavorable (modified Rankin Scale score, 4–6). Results: Of overall 2252 ICH patients, 11.4% (52 of 458) under APT and 14.0% (242 of 1725) without APT presented with thrombocytopenia on admission. The proportion of patients with HE was not significantly different between patients with or without thrombocytopenia among APT and non-APT ICH patients after propensity score matching (HE: APT patients: 9 of 40 [22.5%] thrombocytopenia versus 27 of 115 [23.5%] nonthrombocytopenia, P =0.89; non-APT patients: 54 of 174 [31.0%] thrombocytopenia versus 106 of 356 [29.8%] nonthrombocytopenia, P =0.77). In both (APT and non-APT) propensity score matching cohorts, there were no significant differences regarding functional outcome. Mortality after 3 months did not differ among non-APT patients, whereas the mortality rate was significantly higher for APT patients with thrombocytopenia versus APT patients with normal platelet count (APT: 29 of 46 [63.0%] thrombocytopenia versus 58 of 140 [41.4%] nonthrombocytopenia, P =0.01; non-APT: 95 of 227 [41.9%] thrombocytopenia versus 178 of 455 [39.1%] nonthrombocytopenia, P =0.49). Conclusions: Our study implies that thrombocytopenia does not affect rates of HE and functional outcome among ICH patients, neither in patients with nor without APT. In light of increased mortality, the significance of platelet transfusions for ICH patients with thrombocytopenia and previous APT should be explored in future studies.

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Impact of Preexisting Cognitive Impairment and Race/Ethnicity on Functional Outcomes Following Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.120.030084 ◽

2021 ◽

Vol 52 (2) ◽

pp. 603-610

Author(s):

Russell P. Sawyer ◽

Eunji Yim ◽

Elisheva Coleman ◽

Stacie L. Demel ◽

Padmini Sekar ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Propensity Score ◽

Intracerebral Hemorrhage ◽

Propensity Score Matching ◽

Scale Score ◽

Functional Outcomes ◽

Cognitively Impaired ◽

Modified Rankin Scale ◽

Race Ethnicity

Background and Purpose: In intracerebral hemorrhage (ICH), preexisting cognitive impairment has been identified as a risk factor for increased mortality and morbidity. However, previous studies examined predominantly White populations; therefore, the prevalence and effect of preICH cognitive impairment has not been studied in a multiethnic cohort. This limits the generalizability of previous findings. We sought to investigate the role of preexisting cognitive impairment in a multiethnic population on short-term mortality and functional outcomes after ICH. Methods: Patients with ICH were prospectively enrolled as cases for the GERFHS III (Genetic and Environmental Risk Factors for Hemorrhagic Stroke) Study and the Ethnic/Racial Variations of ICH (ERICH) Study. Cognitive impairment before ICH was defined as positive history of dementia or treatment with donepezil, galantamine, memantine, or rivastigmine on chart abstraction or baseline interview. Specific outcomes—modified Rankin Scale score at 3 months (0–2 versus ≥3), Barthel Index score (<100 versus 100) at 3 months, and withdrawal of care—were analyzed using multivariable logistic regression. Propensity score matching and analysis was done because of imbalances between cognitively impaired and cognitively intact groups. Results: Of the 3537 cases of ICH, 304 patients had cognitive impairment predating ICH. Cognitively impaired subjects were more likely to experience withdrawal of care during hospitalization, and for survivors, greater disability (modified Rankin Scale score of ≥3) and lower Barthel scores after ICH. After propensity score matching, preexisting cognitive impairment was associated with a lower modified Rankin Scale at 3 months in the White, Black, and Hispanic subgroups. Conclusions: Preexisting cognitive impairment was associated with loss of independence 3-month post-ICH, when matching for risk factors of cognitive impairment, in the White, Black, and Hispanic subgroups. This suggests that preexisting cognitive impairment has a negative effect in obtaining functional independence following ICH, irrespective of race/ethnicity.

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Rebleeding drives poor outcome in aneurysmal subarachnoid hemorrhage independent of delayed cerebral ischemia: a propensity-score matched cohort study

Journal of Neurosurgery ◽

10.3171/2019.4.jns19779 ◽

2020 ◽

Vol 133 (2) ◽

pp. 360-368

Author(s):

Victor M. Lu ◽

Christopher S. Graffeo ◽

Avital Perry ◽

Lucas P. Carlstrom ◽

Leonardo Rangel-Castilla ◽

...

Keyword(s):

Cohort Study ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Propensity Score ◽

Functional Outcome ◽

Treatment Modality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Delayed Cerebral Ischemia ◽

Poor Functional Outcome ◽

Poor Outcome

OBJECTIVEDelayed cerebral ischemia (DCI) and aneurysm rebleeding contribute to morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH); however, the relationship between their impacts on overall functional outcome is incompletely understood.METHODSThe authors conducted a cohort study of all aSAH during the study period from 2001 to 2016. Primary end points were overall functional outcome and ischemic aSAH sequelae, defined as delayed cerebral ischemia (DCI), DCI with infarction, symptomatic vasospasm (SV), and global cerebral edema (GCE). Outcomes were compared between the rebleed and nonrebleed cohorts overall and after propensity-score matching (PSM) for risk factors and treatment modality. Univariate and multivariate ordered logistic regression analyses for functional outcomes were performed in the PSM cohort to identify predictors of poor outcome.RESULTSFour hundred fifty-five aSAH cases admitted within 24 hours of aneurysm rupture were included, of which 411 (90%) experienced initial aneurysm ruptures only, while 44 (10%) had clinically confirmed rebleeding. In the overall cohort, rebleeding was associated with significantly worse functional outcome, longer intensive care unit length of stay (LOS), and GCE (all p < 0.01); treatment modality, overall LOS, DCI, DCI with infarction, and SV were nonsignificant. In the PSM analysis of 43 matched rebleed and 43 matched nonrebleed cases, only poor functional outcome and GCE remained significantly associated with rebleeding (p < 0.01 and p = 0.02, respectively). Multivariate regression identified that both rebleeding (HR 21.5, p < 0.01) and DCI (HR 10.1, p = 0.01) independently predicted poor functional outcome.CONCLUSIONSRebleeding and DCI after aSAH are highly morbid and potentially deadly events after aSAH, which appear to have independent negative impacts on overall functional outcome. Early rebleeding did not significantly affect the risk of delayed ischemic complications.

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Can Tirofiban Improve the Outcome of Patients With Acute Ischemic Stroke: A Propensity Score Matching Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.688019 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lingxin Cai ◽

Xiaobo Yu ◽

Jun Yu ◽

Jing Xu ◽

Liang Xu ◽

...

Keyword(s):

Ischemic Stroke ◽

Propensity Score ◽

Acute Ischemic Stroke ◽

Propensity Score Matching ◽

Intracranial Hemorrhage ◽

Subgroup Analysis ◽

Multiple Logistic Regression Analysis ◽

Favorable Outcome ◽

Large Artery ◽

Efficacy And Safety

Objective: To evaluate the efficacy and safety of tirofiban for patients with acute ischemic stroke (AIS), especially posterior circulation stroke (PCS).Methods: We enrolled consecutive patients with AIS who suffered large artery occlusion (LAO) and underwent mechanical thrombectomy (MT) between January 2016 and May 2020. Patients were divided into two groups according to whether tirofiban was used during MT. The primary efficacy outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–2 at 3 months. The safety outcomes were the rate of mortality at 3 months and the presence of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH). Cohorts were balanced using 1:1 propensity score matching (PSM). Subgroup analysis was further performed to compare the efficacy and safety of tirofiban between the anterior circulation stroke (ACS) and PCS groups.Results: A total of 292 patients were eligible for this study and divided into the tirofiban group (n = 51) and the no-tirofiban group (n = 241). In the propensity-score-matched cohort, the tirofiban group had a higher rate of favorable outcomes than the no-tirofiban group (49.0 vs. 25.5%, p = 0.014), and the mortality at 3 months showed a greater downward trend in the tirofiban group than the no-tirofiban group (15.6 vs. 33.3% p = 0.064). The risk of sICH and ICH was the same between the tirofiban and control groups (17.6 vs. 27.4% p = 0.236, 31.3 vs. 45.1% p = 0.154, respectively). Tirofiban use was predictive of favorable outcomes [adjusted odds ratio (aOR) = 2.87, 95% confidence interval (CI) 1.52–6.44, p = 0.043] after multiple logistic regression analysis. Subgroup analysis revealed that tirofiban use was significantly associated with favorable outcomes in ACS (aOR = 3.66, 95% CI 1.24–5.22, p = 0.019) but not in PCS (aOR = 1.12, 95% CI 0.47–7.52, p = 0.570).Conclusion: We demonstrated that tirofiban may be associated with improving favorable outcome for the AIS patients who underwent MT, without increasing ICH or sICH. Furthermore, our results indicated that for PCS patients tirofiban may not be associated with favorable outcome, and more comprehensive randomized controlled trials are needed to confirm this finding.

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Abstract 131: MR-based Selection for Endovascular Therapy in Acute Ischemic Stroke With ICA or MCA Occlusion : Propensity Score Matched Analysis From RESCUE-Japan Registry

Stroke ◽

10.1161/str.46.suppl_1.131 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Yuichi Miyazaki ◽

Hiroshi Yamagami ◽

Kazunori Toyoda ◽

Yukiko Enomoto ◽

Yasushi Okada ◽

...

Keyword(s):

Ischemic Stroke ◽

Propensity Score ◽

Acute Ischemic Stroke ◽

Propensity Score Matching ◽

Endovascular Therapy ◽

Favorable Outcome ◽

Vessel Occlusion ◽

Mca Occlusion ◽

Significant Difference ◽

Nation Wide Survey

Objective: To identify optimal criteria for MR-based endovascular therapy (EVT) in acute ischemic stroke with the internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion. Materials and methods: From RESCUE-Japan registry, a prospective nation-wide survey of acute ischemic stroke with large vessel occlusion, 996 patients diagnosed with ICA or MCA occlusion by initial MRA and assessed with DWI-ASPECTS were included in the present study. We used a propensity score matching method to create a well-balanced cohort to reduce confounding by indication of EVT. Propensity score was calculated using the following variables: sex, age, initial NIHSS score, Onset-to-Door time, DWI-ASPECTS, occluded site on MRA (categorized into four groups, ICA/proximal M1/distal M1/M2 or distal) and IV-tPA. Favorable outcome defined as modified Rankin Scale of 0 to 2 at 90 days after stroke onset was compared between the propensity score-matched groups. Results: Propensity score matching yielded a well-balanced cohort of 528 patients (264 pairs with and without EVT). In this cohort, there was no significant difference in favorable outcome between the patients with and without EVT (33.7% vs 29.2%, OR 1.25, 95% CI 0.855 - 1.81, p=0.25). However, in the subgroup with ICA/proximal M1 occlusion, the patients with EVT more often achieved favorable outcome than the patients without EVT (33.5% vs 17.7%, OR 2.35, 95% CI 1.41 - 3.97), and there was a significant interaction between the cohorts with ICA/proximal M1 occlusion and distal M1/M2 or distal occlusion (p for interaction < 0.001). Further subgroup investigations showed that this effect was concentrated in the patients with NIHSS of 8 to 29 and DWI-ASPECTS of 4 or more (OR 3.28, 95%CI 1.74 - 6.48, p for interaction=0.066). With respect to Onset-to-Door time, optimal threshold was not obtained. Conclusions: MR-based EVT did not show clinical benefit in the overall study population, but significant increase in favorable outcome in the patients with ICA or proximal M1 segment of MCA occlusion. NIHSS of 8 to 29 and DWI-ASPECTS of 4 or more were thought to be optimal thresholds as additional inclusion criteria.

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Abstract T MP67: Different Hematoma Volume Threshold to Predict Favorable Outcome in Basal Ganglia and Thalamic Hemorrhage

Stroke ◽

10.1161/str.46.suppl_1.tmp67 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Kazuma Nakagawa ◽

Sage L King ◽

Megan A Vento ◽

Marissa M Ing ◽

Tracy S Stern ◽

...

Keyword(s):

Basal Ganglia ◽

Functional Outcome ◽

Roc Curve ◽

Outcome Data ◽

Unfavorable Outcome ◽

Favorable Outcome ◽

Modified Rankin Scale ◽

Hematoma Volume ◽

Outcome Group ◽

Ich Score

Background and Purpose: Hematoma volume is the strongest predictor of outcome in intracerebral hemorrhage (ICH). Historically, basal ganglia (BG) and thalamic ICH have been aggregated as “deep” ICH in the prior studies. We assessed whether BG and thalamic ICH have different hematoma volume threshold that is associated with 3-month functional outcome. Design/Methods: From a prospective observational cohort study of ICH patients between July 2011 and May 2014, we compared the hematoma volume of groups that achieved favorable outcome (modified Rankin Scale of 0-2) and unfavorable outcome (modified Rankin Scale of 3-6) at 3 months in BG and thalamic ICH patients. Based on the hematoma size analyses, four different ICH Score models were tested for their accuracy in predicting favorable 3-month outcome, using each component of the original ICH Score except for the hematoma size threshold: ≥30 mL (model 1), ≥15 mL (model 2), ≥10 mL (model 3), and ≥5 mL (model 4). Results: A total of 108 deep ICH patients (60 BG, 48 thalamic) with available 3-month outcome data were studied. For BG ICH, median hematoma volume for favorable outcome group was 10.7 mL [6.2-14.4] and unfavorable outcome group was 40.1 mL [21.0-86.3] (p<0.001). For thalamic ICH, median hematoma volume for favorable outcome group was 2.7 mL [1.2-9.9] and unfavorable outcome group was 9.8 mL [5.4-20.4] (p=0.002). For BG ICH, an area under the ROC curve for the different models of ICH Score was 0.85 (model 1), 0.88 (model 2), 0.84 (model 3), and 0.80 (model 4). For thalamic ICH, an area under the ROC curve was 0.86 (model 1), 0.87 (model 2), 0.85 (model 3), and 0.89 (model 4). Conclusions: Basal ganglia and thalamic ICH have different hematoma volume threshold that is associated with favorable 3-month outcome. Hematoma volume threshold of 15 mL for BG ICH and 5 mL for thalamic ICH may enhance the ICH Score for predicting favorable functional outcome.

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Endovascular Thrombectomy for Treatment of Acute Ischemic Stroke During Pregnancy and the Early Postpartum Period

Stroke ◽

10.1161/strokeaha.121.034303 ◽

2021 ◽

Author(s):

Alis J. Dicpinigaitis ◽

Tolga Sursal ◽

Catherine A. Morse ◽

Camille Briskin ◽

Katarina Dakay ◽

...

Keyword(s):

Ischemic Stroke ◽

Propensity Score ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Propensity Score Matching ◽

Intracranial Hemorrhage ◽

Postpartum Period ◽

Multivariable Analysis ◽

Hospital Length Of Stay ◽

Stroke Severity

Background and Purpose: Acute ischemic stroke (AIS) is a rare occurrence during pregnancy and the postpartum period. Existing literature evaluating endovascular mechanical thrombectomy (MT) for this patient population is limited. Methods: The National Inpatient Sample was queried from 2012 to 2018 to identify and characterize pregnant and postpartum patients (up to 6 weeks following childbirth) with AIS treated with MT. Complications and outcomes were compared with nonpregnant female patients treated with MT and to other pregnant and postpartum patients managed medically. Complex samples regression models and propensity score matching were implemented to assess adjusted associations and to address confounding by indication, respectively. Results: Among 4590 pregnant and postpartum patients with AIS, 180 (3.9%) were treated with MT, and rates of utilization increased following the MT clinical trial era (2015–2018; 1.9% versus 5.3%, P =0.011). Compared with nonpregnant patients with AIS treated with MT, they experienced lower rates of intracranial hemorrhage (11% versus 24%, P =0.069) and poor functional outcome (50% versus 72%, P =0.003) at discharge. Pregnant/postpartum status was independently associated with a lower likelihood of development of intracranial hemorrhage (adjusted odds ratio, 0.26 [95% CI, 0.09–0.70]; P =0.008) following multivariable analysis adjusting for age, illness severity, and stroke severity. Following propensity score matching, pregnant and postpartum patients treated with MT and those medically managed differed in frequency of venous thromboembolism (17% versus 0%, P =0.001) and complications related to pregnancy (44% versus 64%, P =0.034), but not in functional outcome at discharge or hospital length of stay. Pregnant and postpartum women treated with MT did not experience mortality or miscarriage during hospitalization. Conclusions: This large-scale analysis utilizing national claims data suggests that MT is a safe and efficacious therapy for AIS during pregnancy and the postpartum period. In the absence of prospective clinical trials, population-based cross-sectional analyses such as the present study provide valuable clinical insight.

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Early Perihematomal Edema Expansion: Definition, Significance, and Association with Outcomes after Intracerebral Hemorrhage

Oxidative Medicine and Cellular Longevity ◽

10.1155/2021/6249509 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Xin-Ni Lv ◽

Zuo-Qiao Li ◽

Lan Deng ◽

Wen-Song Yang ◽

Yu-Lun Li ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Scale Score ◽

Ct Scans ◽

Absolute Increase ◽

Poor Outcome ◽

Perihematomal Edema ◽

Logistic Regression Procedure ◽

Admission Glasgow Coma Scale

Objective. To investigate the association between early perihematomal edema (PHE) expansion and functional outcome in patients with intracerebral hemorrhage (ICH). Methods. Patients with ICH who underwent initial computed tomography (CT) scans within 6 hours after the onset of symptoms and follow-up CT scans within 24 ± 12 hours were included. Absolute PHE increase was defined as the absolute increase in PHE volume from baseline to 24 hours. A receiver-operating characteristic (ROC) curve was generated to determine the cutoff value for early PHE expansion, which was operationally defined as an absolute increase in PHE volume of >6 mL. The outcome of interest was 3-month poor outcome defined as modified Rankin scale score of ≥4. A multivariable logistic regression procedure was used to assess the association between early PHE expansion and outcome after ICH. Results. In 233 patients with ICH, 89 (38.2%) patients had poor outcome at 3-month follow-up. Early PHE expansion was observed in 56 of 233 (24.0%) patients. Patients with early PHE expansion were more likely to have poor functional outcome than those without (43.8% vs. 11.8%, p < 0.001 ). After adjusting for age, admission systolic blood pressure, admission Glasgow Coma Scale score, baseline ICH volume and the presence of intraventricular hemorrhage, and time from onset to CT, early PHE expansion was associated with poor outcome (adjusted odds ratio, 4.25; 95% confidence interval, 1.70–10.60; p = 0.002 ). Conclusions. The early PHE expansion was not uncommon in patients with ICH and was correlated with poor outcome following ICH.

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