Predictors of severe intracerebral hemorrhage expansion

 Predicting problems does absolutely nothing unless you have created a solution to prevent the problem! I don't see that here, so useless research!

Predictors of severe intracerebral hemorrhage expansion

Andrea Morotti https://orcid.org/0000-0002-6558-1155 andrea.morotti@unibs.it, Qi Li https://orcid.org/0000-0002-9144-148X, […], and Andrea Zini+14View all authors and affiliations

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https://doi.org/10.1177/23969873241247436

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Abstract

Background:

Severe hematoma expansion (sHE) has the strongest impact on intracerebral hemorrhage (ICH) outcome. We investigated the predictors of sHE.

Methods:

Retrospective analysis of ICH patients admitted at nine sites in Italy, Germany, China, and Canada. The following imaging features were analyzed: non-contrast CT (NCCT) hypodensities, heterogeneous density, blend sign, irregular shape, and CT angiography (CTA) spot sign. The outcome of interest was sHE, defined as volume increase >66% and/or >12.5 from baseline to follow-up NCCT. Predictors of sHE were explored with logistic regression.

Results:

A total of 1472 patients were included (median age 73, 56.6% males) of whom 223 (15.2%) had sHE. Age (odds ratio (OR) per year, 95% confidence interval (CI), 1.02 (1.01–1.04)), Anticoagulant treatment (OR 3.00, 95% CI 2.09–4.31), Glasgow Coma Scale (OR 0.93, 95% CI 0.89–0.98), time from onset/last known well to imaging, (OR per h 0.96, 95% CI 0.93–0.99), and baseline ICH volume, (OR per mL 1.02, 95% CI 1.02–1.03) were independently associated with sHE. Ultra-early hematoma growth (baseline volume/baseline imaging time) was also a predictor of sHE (OR per mL/h 1.01, 95% CI 1.00–1.02). All NCCT and CTA imaging markers were also predictors of sHE. Amongst imaging features NCCT hypodensities had the highest sensitivity (0.79) whereas the CTA spot sign had the highest positive predictive value (0.51).

Conclusions:

sHE is common in the natural history of ICH and can be predicted with few clinical and imaging variables. These findings might inform clinical practice and future trials targeting active bleeding in ICH.

Graphical abstract

Introduction

Intracerebral hemorrhage (ICH) is one of the deadliest types of stroke, with high short term mortality and severe neurological sequelae in the majority of survivors.¹ Hematoma expansion (HE) is a potentially preventable determinant(Useless statement without the EXACT PROTOCOL THAT WILL PREVENT THIS EXPANSION!) of poor outcome and represents therefore a compelling therapeutic target.² However, the HE-outcome relationship is not linear, and only severe HE (sHE), defined as hematoma volume increase >66% and/or >12.5 mL, has a significant prognostic impact.³ Previous studies and prediction models focused on the more commonly used definition of HE (volume increase >33% and or >6 mL), whereas predictors of sHE remain poorly characterized.⁴ We aimed to describe the clinical and imaging variables associated with sHE.

 

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