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

 So what in the world makes you think this is worthwhile? Predicting problems with NO solution given. Useless.

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

Gengzhao Ye^1†, Shuna Huang^2†, Renlong Chen^1†, Yan Zheng¹, Wei Huang¹, Zhuyu Gao¹, Lueming Cai¹, Mingpei Zhao¹, Ke Ma², Qiu He¹, Fuxin Lin¹, Yuanxiang Lin¹, Dengliang Wang¹, Wenhua Fang¹, Dezhi Kang^1* and Xiyue Wu^1*

• ¹Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
• ²Department of Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

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.(What EXACTLY will prevent that poor outcome? That's the research that is needed.) Patients with diabetes mellitus, black hole sign, and large initial hematoma volume result in more PHE growth, which should garner attention in the treatment.

Introduction

Spontaneous intracerebral hemorrhage (ICH) is a severe form of stroke and accounts for 10–20% cerebrovascular diseases (1). In the past, the treatment of ICH mainly focused on primary injury and inhibiting hematoma growth. However, these treatment strategies do not seem to have achieved satisfactory results (2, 3). More and more attention has been paid to the secondary damage after cerebral hemorrhage.

After the initial injury caused by brain tissue disruption and mass effect of the hematoma, the activation of a coagulation cascade reaction, inflammatory cell infiltration, and the product of erythrocyte rupture triggers a series of secondary harmful events, eventually leading to the formation of perihematomal edema (PHE) (2, 4–6). A growing body of research shows that PHE was associated with poor functional outcomes after ICH (7–13), and treatment strategies to attenuate PHE are likely to improve patient outcomes (14). PHE progresses fastest in the first 2 to 3 days (4), which leaves a therapeutic time window. Therefore, early identification of risk factors associated with PHE growth may allow for the implementation of a more aggressive treatment strategy.

In this study, we aimed to explore the relationship between PHE and poor outcome and, more importantly, to find out the predictors of PHE growth.