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 TP310: Subarachnoid Extension of Intracerebral Hemorrhage and Perihematomal Ischemic Compression Are Related, Harmful Processes

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 ◽  
Binary Logistic Regression ◽  
Brain Parenchyma ◽  
Hematoma Volume ◽  
Logistic Regression Models ◽  
Ordinal Regression Model ◽  
Hemorrhage Volume ◽  
Poor Outcomes ◽  
Unique Markers ◽  
Ich Score

Background: Decreased diffusion is associated with poor outcomes in primary intracerebral hemorrhage (ICH), although the mechanism of that phenomenon is uncertain. Two distinct types of decreased diffusion have been observed, perihematomal ischemia (PHI) and distant areas of ischemia. Extension of hemorrhage into the subarachnoid (SAH) and intraventricular (IVH) compartments may be indicators of high perihematomal pressures and diminished brain parenchyma compliance. The objective of this study is to evaluate for an association between PHI and poor outcomes, and to evaluate whether PHI is associated with SAH and IVH as markers of injurious perihematomal pressure. 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. MRI was performed on all salvageable patients when possible. SAH, IVH and PHI were identified on imaging, along with ICH volumes, by expert reviewers blinded to outcomes. An ordinal regression model was used to evaluate for an association between PHI and modified Rankin Scale (mRS) at 28 days, adjusted for ICH Score. A binary logistic regression models was developed to identify an association between PHI and other potential predictors of malignant peri-hematomal pressures: SAH, IVH, initial hematoma volume, and supra- versus infratentorial location. Results: 94 patients were studied. 27 (28.7%) had SAH and 44 (46.8%) had IVH. PHI was associated with mRS at 28 days (odds ratio 2.88 [95% CI 1.23-6.75]), independent of ICH Score. PHI was associated with SAH (3.74 [1.25-11.21]), whereas no significant association was found with IVH, hematoma volume or location. Conclusions: PHI is independently associated with poor outcomes in primary ICH. PHI is associated with SAH, but not hemorrhage volume, location or decompression into the ventricular system. These findings suggest that PHI and subarachnoid hemorrhage extension are associated, unique markers for injurious perihematomal pressure.

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.

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 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.

Abstract P394: Association Between Admission Dehydration and In-Hospital Mortality in Patients With Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Bin Gao ◽  
Hongqiu Gu ◽  
Shimeng Liu ◽  
Qi Zhou ◽  
Kang Kaijiang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Blood Urea Nitrogen ◽  
Regression Models ◽  
Fluid Management ◽  
Urea Nitrogen ◽  
Logistic Regression Models ◽  
Acute Intracerebral Hemorrhage ◽  
Stroke Center

Background and purpose: Our aim was to investigate the associations between dehydration status at admission and in-hospital mortality in patients with intracerebral hemorrhage. Methods: Data of consecutive patients with intracerebral hemorrhage between August 2015 and July 2019 based on China Stroke Center Alliance (CSCA) were analyzed. The patients were stratified based on the blood urea nitrogen (BUN) to creatinine (CR) ratio (BUN/CR) on admission, into dehydrated (BUN/CR ≥ 15) and non-dehydrated (BUN/CR < 15) groups. Data were analyzed with multi-variate logistic regression models to analyze the risks of death at hospital and baseline dehydration status. Results: A total number of 84043 patients with intracerebral hemorrhage were included in the study. The median age of patients on admission was 63.0 years, and 37.5% of them were women. Based on the baseline BUN/CR, 59153 (70.4%) patients were classified into dehydration group. Patients with admission dehydration (BUN/CR ≥ 15) had 13% lower risks of in-hospital mortality than those without dehydration (BUN/CR < 15, adjusted OR=0.87, 95%CI: [0.78-0.96]). In patients aged <65 years, patients with baseline dehydration (BUN/CR ≥ 15) showed 19% lower risks of in-hospital mortality (adjusted OR=0.81, 95%CI: [0.70-0.94].adjusted p=0.0049) than non-dehydrated patients (BUN/CR<15). Conclusion: Admission dehydration is associated with lower in-hospital mortality in intracerebral hemorrhage,which provides an imaging clue that fluid management could be important for acute intracerebral hemorrhage.

scholarly journals Mediation effects of mean Hounsfield unit on relationship between hemoglobin and expansion of intracerebral hemorrhage

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yong Soo Kim ◽  
Han-Gil Jeong ◽  
Hee-Yun Chae ◽  
Beom Joon Kim ◽  
Jihoon Kang ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Mediation Analysis ◽  
Hounsfield Unit ◽  
Mediation Effect ◽  
Hematoma Expansion ◽  
Hematoma Volume ◽  
Mediation Effects ◽  
Potential Marker ◽  
Baseline Systolic Blood Pressure ◽  
The Mean

AbstractLow hemoglobin levels are known to be associated with hematoma expansion (HE) and poor functional outcome in patients with intracerebral hemorrhage (ICH). However, it is not yet known whether low hemoglobin itself causes HE directly or is merely a confounder. Thus, we investigated the mediation effect of the mean Hounsfield unit (HU) of hematoma on the relationship between low hemoglobin and expansion of ICH. Overall, 232 consecutive patients with ICH who underwent non-contrast computed tomography (NCCT) within 12 h since onset were included. The mean HU and hematoma volume on NCCT were investigated using semi-automated planimetry. HE was defined as an increase in hematoma volume > 33% or 6 mL. The respective associations among the hemoglobin level, mean HU, and HE were analyzed using multivariable regression analysis, adjusting for age, sex, and known HE predictors. Mediation analysis was performed to examine the potential causal association among the three. HE occurred in 34.5% of patients; hemoglobin levels were inversely associated with HE occurrence (adjusted odds ratio, 0.90; p = 0.03). The mean HU of the hematoma was lower in patients with HE than in patients without HE (58.5 ± 3.3 vs. 56.8 ± 3.0; p < 0.01). Hemoglobin levels on admission were linearly related to the mean HU (adjusted β, 0.33; p < 0.01) after adjusting for known HE predictors (time from onset to CT, antithrombotic use, hematoma volume). Causal mediation analysis showed a significant mediation effect of the mean HU on the association between hemoglobin levels and HE (p = 0.04). The proportion of indirect effect through the mean HU among the total effect was 19% (p = 0.05). The mediation effect became nonsignificant in the when the multivariable model was adjusted with additional covariates (baseline systolic blood pressure and hematoma location). The mean HU of the hematoma mediated the association between hemoglobin levels and HE occurrence. Therefore, the mean HU of the hematoma may be a potential marker of impaired hemostasis in patients with ICH.

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

Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

2021 ◽  
pp. 174749302110616
Author(s):  
Arba Francesco ◽  
Rinaldi Chiara ◽  
Boulouis Gregoire ◽  
Fainardi Enrico ◽  
Charidimou Andreas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Significant Risk ◽  
Irregular Shape ◽  
Hematoma Expansion ◽  
Logistic Regression Models ◽  
Noncontrast Computed Tomography

Background and purpose Assess the diagnostic accuracy of noncontrast computed tomography (NCCT) markers of hematoma expansion in patients with primary intracerebral hemorrhage. Methods We performed a meta-analysis of observational studies and randomized controlled trials with available data for calculation of sensitivity and specificity of NCCT markers for hematoma expansion (absolute growth >6 or 12.5 mL and/or relative growth >33%). The following NCCT markers were analyzed: irregular shape, island sign (shape-related features); hypodensity, heterogeneous density, blend sign, black hole sign, and swirl sign (density-related features). Pooled accuracy values for each marker were derived from hierarchical logistic regression models. Results A total of 10,363 subjects from 23 eligible studies were included. Significant risk of bias of included studies was noted. Hematoma expansion frequency ranged from 7% to 40%, mean intracerebral hemorrhage volume from 9 to 27.8 ml, presence of NCCT markers from 9% (island sign) to 82% (irregular shape). Among shape features, sensitivity ranged from 0.32 (95%CI = 0.20–0.47) for island sign to 0.68 (95%CI = 0.57–0.77) for irregular shape, specificity ranged from 0.47 (95%CI = 0.36–0.59) for irregular shape to 0.92 (95%CI = 0.85–0.96) for island sign; among density features sensitivity ranged from 0.28 (95%CI = 0.21–0.35) for black hole sign to 0.63 (95%CI = 0.44–0.78) for hypodensity, specificity ranged from 0.65 (95%CI = 0.56–0.73) for heterogeneous density to 0.89 (95%CI = 0.85–0.92) for blend sign. Conclusion Diagnostic accuracy of NCCT markers remains suboptimal for implementation in clinical trials although density features performed better than shape-related features. This analysis may help in better tailoring patients’ selection for hematoma expansion targeted trials.

Abstract 1122‐000215: Scheduled Head CT in Neurologically Stable Spontaneous ICH Patients May be Unnecessary

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mohammad Almajali ◽  
Farid Khasiyev ◽  
Abdullah M Hakoun ◽  
M. Khurram Afzal ◽  
Michael Sunnaa ◽  
...  
Keyword(s):  
Neurological Status ◽  
Hematoma Expansion ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Head Ct ◽  
Neuroimaging Data ◽  
Population Sizes ◽  
Initial Imaging ◽  
Ich Score

Introduction : Obtaining serial head computed tomography (CTH) imaging for patients with spontaneous intracerebral hemorrhage (sICH) is commonly utilized to monitor for hematoma expansion (HE), defined as an increase in ICH volume by 33%. Obtaining recurrent CTH in the ICU setting may burden nursing and transport staff, expose patients to radiation, and inflate healthcare costs. It remains unclear whether utilizing scheduled CTH for sICH patients is more advantageous than targeted CTH, which is prompted by a decline in neurological status. We reviewed clinical factors and imaging studies in patients with and without HE. Methods : This retrospective cohort study conducted over two years identified 171 sICH patients. Patient demographics, clinical and neuroimaging data were recorded (including the reason for repeat imaging). These variables were then compared and analyzed in relation to HE using SPSS version 26, chi‐square tests for categorical variables, and independent‐samples t‐tests were used for continuous variables. Results : Patients were predominantly male (65%), with a mean age of 65±14 years, a median GCS of 14, a median ICH score of 1, and a median ICH volume of 12.1 ccs. Repeat CTH was obtained within 14 hours after the initial imaging on average. Admission blood pressure (BP), BP‐lowering interventions, pre‐admission use of anticoagulant and antiplatelet therapy, GCS on admission, ICH volume, ICH score, and presence of spot signs were similar between the two groups. 15% of total patients (26/171) had HE. In the group that underwent scheduled repeat CTH, only 7% (9 patients) had HE, while the remaining 93% (119 patients) did not. Patients who underwent a second scan following a change in the neurologic assessment included 39% (17 patients) who had HE, compared to 61% (26 patients) that did not. HE detection was significantly lower in patients that underwent scheduled CTH (p < 0.0001). Conclusions : In patients with a stable exam, scheduled head CT only showed HE in 6% of patients; thus, the excess burden, radiation, and costs may not be necessary for these patients. Hematoma expansion is significantly lower in patients who underwent scheduled imaging than those prompted by a decline in neurologic status. However, our sample size is small and additional studies with larger population sizes are required to validate our findings.

Sign in / Sign up

Export Citation Format

Share Document