Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume
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Abstract
Background and Objectives Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE.
Methods This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (<0%), mild (0%–33%), moderate (33.1%–66%), and severe (>66%). Absolute HE (aHE) was classified as none (<0 mL), mild (0–6.0 mL), moderate (6.1–12.5 mL), and severe (>12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4–6) were explored with logistic regression.
Results We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%, p < 0.001 and 18.3% vs 7.2%, p < 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38–2.82, p < 0.001; aHE OR 1.73, 95% CI 1.23–2.45, p = 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL.
Discussion The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies.
Glossary
- aHE=
- absolute HE;
- GCS=
- Glasgow Coma Scale;
- HE=
- hematoma expansion;
- ICH=
- intracerebral hemorrhage;
- IVH=
- intraventricular hemorrhage;
- mRS=
- modified Rankin Scale;
- NCCT=
- noncontrast CT;
- OR=
- odds ratio;
- rHE=
- relative HE
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
- Received December 20, 2022.
- Accepted in final form June 14, 2023.
- © 2023 American Academy of Neurology
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