Perihematomal edema as predictor of outcome in spontaneous intracerebral hemorrhage

ABSTRACT Background: Spontaneous intracerebral hemorrhage (SICH) is a form of cerebrovascular accident with a very high rate of morbidity and mortality. The determinants of prognosis include the demographic, clinical, laboratory, and radiologic factors. It is long known that the hematoma size has a negative impact on the outcome in SICH. The influence of perihematomal edema (PHE) is not established to the extent same as that of hematoma volume. Hence, we planned this study to determine as to what role does PHE plays in the outcome in SICH. Aim of the Study: To evaluate the prognostic influence of absolute and relative edema (ratio of absolute edema to hematoma volume) in the patients of SICH. Materials and Methods: This is a prospective case-controlled study. A total of 44 patients were enrolled after excluding the confounding factors. The patients were evaluated and their disability was assessed using modified Rankin scale (MRS). The imaging was done in the interval between 24 and 72 h and the hematoma volume, absolute edema volume, and the relative edema were calculated. The outcome was reassessed at 12 weeks and defined as favorable if MRS < 3. Results: A total of 69 patients were found to be having SICH on imaging; however, 25 patients were excluded as they had one of the criterion for exclusion. Hence, only 44 patients were included in the study. On univariate analysis, none of the demographic characteristics of the patients, vascular risk factors, presenting complaints, blood pressure, Glasgow coma scale, and MRS at admission, laboratory parameters were not significantly different in the two outcome groups. The hematoma volume was significantly higher in the poor outcome group (P < 0.0001) and the relative edema was associated with a favorable outcome at 12 weeks (P < 0.0001). On multivariate logistic regression, the hematoma volume and relative edema were found to have effect on the outcome similar to that seen on univariate analysis. Conclusion: In SICH, a larger hematoma volume is a predictor of poor outcome and a relative edema is associated with a better functional status.

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

Frontiers in Neurology ◽

10.3389/fneur.2021.700166 ◽

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 < 0.001, β = 21.62 95% CI 10.10–33.15).Conclusions: An increase of PHE volume >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.

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Nosocomial Infections in Patients With Spontaneous Intracerebral Hemorrhage

American Journal of Critical Care ◽

10.4037/ajcc2015422 ◽

2015 ◽

Vol 24 (3) ◽

pp. 227-231 ◽

Cited By ~ 18

Author(s):

Archana Hinduja ◽

Jamil Dibu ◽

Eugene Achi ◽

Anand Patel ◽

Rohan Samant ◽

...

Keyword(s):

Nosocomial Infection ◽

Intracerebral Hemorrhage ◽

Nosocomial Infections ◽

Odds Ratio ◽

Intraventricular Hemorrhage ◽

Univariate Analysis ◽

Multivariate Regression Analysis ◽

Spontaneous Intracerebral Hemorrhage ◽

Percutaneous Gastrostomy ◽

Poor Outcome

Background Nosocomial infections are frequent complications in patients with intracerebral hemorrhage. Objectives To determine the prevalence, risk factors, and outcomes of nosocomial infections in patients with intracerebral hemorrhage. Methods Prospectively collected data on patients with spontaneous intracerebral hemorrhage between January 2009 and June 2012 were retrospectively reviewed. Patients who had nosocomial infection during the hospital stay were compared with patients who did not. Poor outcome was defined as death or discharge to a long-term nursing facility. Results At least 1 nosocomial infection developed in 26% of 202 patients with intracerebral hemorrhage. The most common infections were pneumonia (18%), urinary tract infection (12%), meningitis or ventriculitis (3%), and bacteremia (1%). On univariate analysis, independent predictors of nosocomial infection were intraventricular hemorrhage, hydrocephalus, low score on the Glasgow Coma Scale at admission, hyperglycemia at admission, and treatment with mechanical ventilation. On multivariate regression analysis, the only significant predictor of nosocomial infection was intraventricular hemorrhage (odds ratio, 5.4; 95% CI, 1.2–11.4; P = .02). Patients with nosocomial infection were more likely than those without to require a percutaneous gastrostomy tube (odds ratio, 33.1, 95% CI, 23.3–604.4; P < .001) and to have a longer stay in the intensive care unit or hospital without a significant increase in mortality. Patients with nosocomial pneumonia were also more likely to have a poor outcome (P < .001). Conclusion Pneumonia was the most common infection among patients with intracerebral hemorrhage.

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Abstract W P326: Comparison of Spontaneous Intracerebral Hemorrhage Outcomes in Patients with Warfarin and Antiplatelet Medication Use

Stroke ◽

10.1161/str.46.suppl_1.wp326 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Santosh Murthy ◽

Yogesh Moradiya ◽

Jesse Dawson ◽

Kennedy Lees ◽

Daniel F Hanley ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcomes ◽

Intraventricular Hemorrhage ◽

Hematoma Expansion ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume ◽

Computed Tomographic ◽

Warfarin Group ◽

Antiplatelet Medication ◽

Perihematomal Edema

Background: Use of antiplatelet medications and warfarin has been associated with poor clinical outcomes in spontaneous intracerebral hemorrhage (ICH). However, a head to head comparison between these groups has not been performed. We compared ICH outcomes among patients on these medications. Methods: In this cohort study, we analyzed 987 patients with ICH from the Virtual International Stroke Trials Archive. Patients with ICH presented within six-hours of symptom onset had baseline clinical, radiological data, and computed tomographic scan at 72 hours. Hematoma expansion was defined as interval increase in size by >33%. Main outcome variables were 90-day mortality, and modified Rankin Score (mRS) at 90 days dichotomized into 0-3 vs 4-6. Results: Of 987 ICH patients 154 had prior antiplatelet use, 30 had warfarin, and 803 had neither of the two medications. The warfarin group had significantly higher age (p<0.001) and higher prevalence of atrial fibrillation (p<0.001). Of the ICH characteristics, comparing warfarin, antiplatelet and no warfarin/antiplatelet cohorts, the warfarin group had lower Glasgow coma scale (GCS) scores (p=0.049), higher intraventricular hemorrhage (IVH) rate (p=0.010), and more hydrocephalus (p<0.001). Hematoma expansion at 72 hours was significantly higher with warfarin use (p=0.003), while the ratio of perihematomal edema volume to hematoma volume at 72 hours was lowest with warfarin use (p<0.001). In the logistic regression model adjusted for age, sex, race, hematoma volume, perihematomal edema, GCS, IVH and hydrocephalus; warfarin patients had significantly lower odds of achieving mRS 0-3 (OR: 0.23, 95% CI: 0.06-0.83, p=0.025), while the antiplatelet group had similar functional outcomes compared to no warfarin/antiplatelet use (OR: 0.75, 95% CI: 0.46-1.23, p=0.260). The 90-day mortality outcomes were not significantly different across the three groups (18.7% to 40.3%, p=0.520). Conclusion: Warfarin use is associated with a higher incidence of hydrocephalus, intraventricular hemorrhage and hematoma expansion, but lesser perihematomal edema relative to the hematoma volume. Warfarin associated ICH appears to be independently associated with worse functional outcomes but not with 90-day mortality in ICH.

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Association of pre- and post-stroke glycemic status with clinical outcome in spontaneous intracerebral hemorrhage

Scientific Reports ◽

10.1038/s41598-019-55610-z ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Kaijiang Kang ◽

Jingjing Lu ◽

Yi Ju ◽

Wenjuan Wang ◽

Yuan Shen ◽

...

Keyword(s):

Blood Glucose ◽

Clinical Outcome ◽

Intracerebral Hemorrhage ◽

Fasting Blood Glucose ◽

Spontaneous Intracerebral Hemorrhage ◽

Glycemic Status ◽

Hematoma Volume ◽

Post Stroke ◽

Risk Of Death ◽

Poor Outcome

AbstractIn this study, we aimed to disclose the association of pre- and post-stroke glycemic status with clinical outcome in patients with spontaneous intracerebral hemorrhage (sICH). It was a multicenter, prospective, observational cohort study, conducted in 13 hospitals in Beijing from January 2014 to September 2016. The association of admission random blood glucose (RBG), fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) with clinical outcome at 90 days after sICH onset were analyzed comprehensively. Poor outcome was defined as death or modified Rankin Scale (mRS) score >2. The results showed that elevated RBG and FBG were associated with larger hematoma volume, lower GCS, higher NIHSS (P < 0.001), and poor outcome, but HbA1c was not (P > 0.05). In stratified analysis, the association of poor outcome with elevated FBG or RBG retained statistical significance just in patients without diabetes. Kaplan-Meier curve and Cox regression showed that patients with elevated FBG or RBG had significantly higher risk of death within 90 days (P < 0.05). So we conclude that poststroke hyperglycemia was associated with larger hematoma volume, severe neurological damage and poor clinical outcome, but HbA1c was not relevant to hematoma volume or clinical outcome in patients with sICH.

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Anti-inflammatory genes in PBMCs post-spontaneous intracerebral hemorrhage

Translational Neuroscience ◽

10.1515/tnsci-2021-0003 ◽

2021 ◽

Vol 12 (1) ◽

pp. 58-66

Author(s):

Doan Nguyen ◽

Vi Tran ◽

Alireza Shirazian ◽

Cruz Velasco-Gonzalez ◽

Ifeanyi Iwuchukwu

Keyword(s):

Intracerebral Hemorrhage ◽

Negative Correlation ◽

Mononuclear Cells ◽

Inflammatory Cells ◽

Favorable Outcome ◽

Hospital Length Of Stay ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume ◽

Peripheral Blood Mononuclear ◽

Anti Inflammatory

Abstract Background Neuroinflammation is important in the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and peripheral inflammatory cells play a role in the clinical evolution and outcome. Methodology Blood samples from ICH patients (n = 20) were collected at admission for 5 consecutive days for peripheral blood mononuclear cells (PBMCs). Frozen PBMCs were used for real-time PCR using Taqman probes (NFKB1, SOD1, PPARG, IL10, NFE2L2, and REL) and normalized to GAPDH. Data on hospital length of stay and modified Rankin score (MRS) were collected with 90-day MRS ≤ 3 as favorable outcome. Statistical analysis of clinical characteristics to temporal gene expression from early to delayed timepoints was compared for MRS groups (favorable vs unfavorable) and hematoma volume. Principle findings and results IL10, SOD1, and REL expression were significantly higher at delayed timepoints in PBMCs of ICH patients with favorable outcome. PPARG and REL increased between timepoints in patients with favorable outcome. NFKB1 expression was not sustained, but significantly decreased from higher levels at early onset in patients with unfavorable outcome. IL10 expression showed a negative correlation in patients with high hematoma volume (>30 mL). Conclusions and significance Anti-inflammatory, pro-survival regulators were highly expressed at delayed time points in ICH patients with a favorable outcome, and IL10 expression showed a negative correlation to high hematoma volume.

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Fully Automated Segmentation Algorithm for Perihematomal Edema Volumetry After Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.119.026764 ◽

2020 ◽

Vol 51 (3) ◽

pp. 815-823 ◽

Cited By ~ 1

Author(s):

Natasha Ironside ◽

Ching-Jen Chen ◽

Simukayi Mutasa ◽

Justin L. Sim ◽

Dale Ding ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Segmentation Algorithm ◽

Automated Segmentation ◽

Spontaneous Intracerebral Hemorrhage ◽

Perihematomal Edema

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17p12 Influences Hematoma Volume and Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.117.020091 ◽

2018 ◽

Vol 49 (7) ◽

pp. 1618-1625 ◽

Cited By ~ 9

Author(s):

Sandro Marini ◽

William J. Devan ◽

Farid Radmanesh ◽

Laura Miyares ◽

Timothy Poterba ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume

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Abstract TP326: Lymphopenia, Infectious Complications and Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/str.48.suppl_1.tp326 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Andrea Morotti ◽

Sandro Marini ◽

Michael J Jessel ◽

Kristin Schwab ◽

Alison M Ayres ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Lymphocyte Count ◽

Cox Regression ◽

Case Fatality ◽

Retrospective Chart Review ◽

Infectious Complications ◽

Multiple Infections ◽

Spontaneous Intracerebral Hemorrhage ◽

Poor Outcome ◽

Increased Risk

Background and Purpose: lymphopenia is increasingly recognized as a consequence of acute illness and may predispose to infections. We investigated whether admission lymphopenia (AL) is associated with increased risk of infectious complications and poor outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods: we analyzed a prospectively collected cohort of ICH patients ascertained between 1994 and 2015. Subjects were included if they had a lymphocyte count obtained within 24 h from onset and AL was defined as lymphocyte count<1000/uL. Infectious complications were assessed through retrospective chart review and the association between AL, infectious complications and mortality was investigated with a multivariable Cox regression and logistic regression respectively. Results: 2014 patients met the inclusion criteria (median age 75, males 54.0%) of whom 548 (27.2%) had AL and 605 (30.0%) experienced an infectious complication. Overall case fatality at 90 days was 36.9%. Patients with AL were more severely affected, as highlighted by larger hematoma volume, higher frequency of intraventricular hemorrhage and lower Glasgow Coma Scale score (all p<0.001). AL was independently associated with increased risk of pneumonia (Hazard Ratio [HR] 1.65, 95% confidence interval [CI] 1.32-2.05, p<0.001) and multiple infections (HR 1.75, 95% CI 1.22-2.51, p=0.002). The association with urinary tract infection, sepsis or other infections was not significant. AL was also an independent predictor of 90-day mortality (odds ratio 1.55, 95% CI 1.18-2.04, p=0.002) after adjusting for confounders. Conclusions: AL is common in ICH and associated with increased risk of infectious complications and poor outcome. Further studies will be needed to determine whether prophylactic antibiotics in ICH patients with AL can improve outcome.

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