Lower Ionized Calcium Predicts Hematoma Expansion and Poor Outcome in Patients with Hypertensive Intracerebral Hemorrhage

2018 ◽  
Vol 118 ◽  
pp. e500-e504 ◽  
Author(s):  
Yi-Bin Zhang ◽  
Shu-Fa Zheng ◽  
Pei-Sen Yao ◽  
Guo-Rong Chen ◽  
Guang-Hai Li ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ionized Calcium ◽  
Hematoma Expansion ◽  
Poor Outcome ◽  
Hypertensive Intracerebral Hemorrhage

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

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.

scholarly journals Radiomics for intracerebral hemorrhage: are all small hematomas benign?

2020 ◽  
Author(s):  
Chen-yi Zhan ◽  
Qian Chen ◽  
Ming-yue Zhang ◽  
Jin-jin Liu ◽  
Yi-lan Xiang ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Operating Characteristic ◽  
Predictive Performance ◽  
Hematoma Expansion ◽  
Short Term ◽  
Discrimination Ability ◽  
Poor Outcome ◽  
Noncontrast Ct ◽  
Relationship Of ◽  
The Relationship

Abstract Background: Radiomics is a valuable tool for predicting hematoma expansion (HE) but has not been used for small intracerebral hemorrhage (ICH). We hypothesized that not all small hematomas are benign and that radiomics could predict HE and short-term outcomes in small hematomas.Methods: We analyzed 313 patients with small ICH who underwent baseline noncontrast CT within 6 h of symptom onset between September 2013 and February 2019. Small ICH was defined as baseline hematoma volume <10 mL. A radiomic score (R-score) was developed in a training (n=218) and validated in a test cohort (n=95). Poor outcome was defined as a Glasgow Outcome Scale score ≤3. The relationship of the R-score with HE and outcomes was investigated using univariate and multivariate analyses. Predictive performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC).Results: R-score was an independent predictor of HE in the training (odds ratio [OR]: 2.557; 95% CI, 1.455–4.492) and test cohorts (OR, 3.985; 95% CI, 1.051–14.453). In the 3–10 mL subgroup, but not in the <3 ml subgroup, the R-score was independently associated with HE (OR, 4.293; 95% CI, 2.095–8.796) and poor outcome (OR, 1.297; 95%CI, 1.004–1.674) after adjusting for confounders. The R-score achieved good discrimination ability for HE in the training and test cohorts and the 3–10 mL subgroup (AUCs 0.728, 0.717, and 0.740, respectively).Conclusions: Radiomics provides an objective and effective approach for discriminating between benign and malignant course in patients with small ICH, particularly 3–10 mL hematomas.

Abstract P410: Association of Serum GFAP With Hematoma Expansion and Poor Outcome After Intracerebral Hemorrhage: The Factor VII for ICH Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Audrey C Leasure ◽  
Kevin N Vanent ◽  
Matthew Bevers ◽  
William T Kimberly ◽  
Stephan A Mayer ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Factor Vii ◽  
Hematoma Expansion ◽  
Recombinant Activated Factor Vii ◽  
Poor Outcome ◽  
Blood Brain Barrier Disruption ◽  
Activated Factor Vii ◽  
Absolute Volume ◽  
Brain Barrier Disruption ◽  
Multivariable Regression Models

Background: Biomarkers may help identify patients most likely to benefit from therapies. We tested whether serum glial fibrillary acidic protein (GFAP), a biomarker elevated early after intracerebral hemorrhage (ICH) in response to blood-brain barrier disruption, is associated with hematoma expansion (HE) and outcome after ICH and whether GFAP levels modify the effect of factor VII treatment. Methods: We performed an exploratory analysis of the recombinant activated factor VII for acute ICH (FAST) trial. FAST collected serum GFAP levels were collected at admission within 4 hours of ICH onset prior to factor VII treatment. We used regression analyses to evaluate the associations between serum GFAP, HE (dichotomized as &gte; 33% or &gt; 6 mL increase in ICH volume from baseline to 24h and as the absolute volume of expansion), and 3-month poor outcome (modified Rankin Scale score 4-6). We tested for interaction between GFAP and factor VII treatment by adding product terms to multivariable regression models. Results: Of 841 enrolled patients, we included 567 (67%) with available GFAP levels (mean age 64 [SD 13], female sex 203 [37%]). GFAP was associated with HE (adjusted odds ratio [OR] 1.54, 95% CI 1.10-2.17) and poor outcome (adjusted OR 1.86, 95% CI 1.18-3.09). Compared to patients in the lowest GFAP quartile, those in the highest quartile had 2 times the odds of HE (95% CI 1.08-3.89) and 2.7 times the odds of a poor outcome (95% CI 1.33-5.70). GFAP modified the association between factor VII treatment and HE volume (multivariable interaction p=0.04): treatment was not associated with reduced HE volume in the lowest GFAP quartile (β -0.44, 95% CI -3.54 to 2.67), but was associated with reduced HE volume in higher quartiles (β -3.82, 95% CI -7.58 to -0.06). Conclusions: In the FAST trial population, early GFAP levels were associated with HE and poor functional outcome. Factor VII treatment was associated with a greater reduction in HE volume in patients with higher GFAP levels. Serum GFAP may be useful for risk-stratifying patients early after ICH onset.

scholarly journals New and expanding ventricular hemorrhage predicts poor outcome in acute intracerebral hemorrhage

Neurology ◽  
2019 ◽  
Vol 93 (9) ◽  
pp. e879-e888 ◽  
Author(s):  
Vignan Yogendrakumar ◽  
Tim Ramsay ◽  
Dean Fergusson ◽  
Andrew M. Demchuk ◽  
Richard I. Aviv ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Volume Change ◽  
Massachusetts General Hospital ◽  
Nonlinear Models ◽  
Hematoma Expansion ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Poor Outcome ◽  
Fractional Polynomial

ObjectiveTo describe the relationship between intraventricular hemorrhage (IVH) expansion and long-term outcome and to use this relationship to select and validate clinically relevant thresholds of IVH expansion in 2 separate intracerebral hemorrhage (ICH) populations.MethodsWe used fractional polynomial analysis to test linear and nonlinear models of 24-hour IVH volume change and clinical outcome with data from the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT)-ICH study. The primary outcome was poor clinical outcome (modified Rankin Scale [mRS] score 4–6) at 90 days. We derived dichotomous thresholds from the selected model and calculated diagnostic accuracy measures. We validated all thresholds in an independent single-center ICH cohort (Massachusetts General Hospital).ResultsOf the 256 patients from PREDICT, 127 (49.6%) had an mRS score of 4 to 6. Twenty-four–hour IVH volume change and poor outcome fit a nonlinear relationship, in which minimal increases in IVH were associated with a high probability of an mRS score of 4 to 6. IVH expansion ≥1 mL (n = 53, sensitivity 33%, specificity 92%, adjusted odds ratio [aOR] 2.68, 95% confidence interval [CI] 1.11–6.46) and development of any new IVH (n = 74, sensitivity 43%, specificity 85%, aOR 2.53, 95% CI 1.22–5.26) strongly predicted poor outcome at 90 days. The dichotomous thresholds reproduced well in a validation cohort of 169 patients.ConclusionIVH expansion as small as 1 mL or any new IVH is strongly predictive of poor outcome. These findings may assist clinicians with bedside prognostication and could be incorporated into definitions of hematoma expansion to inform future ICH treatment trials.

Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage

2018 ◽  
Vol 45 (1-2) ◽  
pp. 48-53 ◽  
Author(s):  
Qi Li ◽  
Wen-Song Yang ◽  
Sheng-Li Chen ◽  
Fu-Rong Lv ◽  
Fa-Jin Lv ◽  
...  
Keyword(s):  
Black Hole ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Functional Outcome ◽  
Multivariate Logistic Regression Analysis ◽  
Hematoma Expansion ◽  
Poor Functional Outcome ◽  
Poor Outcome ◽  
Prognostic Stratification

Background: In spontaneous intracerebral hemorrhage (ICH), black hole sign has been proposed as a promising imaging marker that predicts hematoma expansion in patients with ICH. The aim of our study was to investigate whether admission CT black hole sign predicts hematoma growth in patients with ICH. Methods: From July 2011 till February 2016, patients with spontaneous ICH who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. The presence of black hole sign on admission non-enhanced CT was independently assessed by 2 readers. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Univariate and multivariable logistic regression analyses were performed to assess the association between the presence of the black hole sign and functional outcome. Results: A total of 225 patients (67.6% male, mean age 60.3 years) were included in our study. Black hole sign was identified in 32 of 225 (14.2%) patients on admission CT scan. The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, baseline ICH volume, admission Glasgow Coma Scale score, and presence of black hole sign on baseline CT independently predict poor functional outcome at 90 days. There are significantly more patients with a poor functional outcome (defined as mRS ≥4) among patients with black hole sign than those without (84.4 vs. 32.1%, p < 0.001; OR 8.19, p = 0.001). Conclusions: The CT black hole sign independently predicts poor outcome in patients with ICH. Early identification of black hole sign is useful in prognostic stratification and may serve as a potential therapeutic target for anti-expansion clinical trials.

Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome

Neurology ◽  
2020 ◽  
Vol 95 (14) ◽  
pp. 632-643 ◽  
Author(s):  
Andrea Morotti ◽  
Francesco Arba ◽  
Gregoire Boulouis ◽  
Andreas Charidimou
Keyword(s):  
Intracerebral Hemorrhage ◽  
Randomized Controlled Trials ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Hematoma Expansion ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Poor Outcome ◽  
Increased Risk ◽  
Noncontrast Ct

ObjectiveTo provide precise estimates of the association between noncontrast CT (NCCT) markers, hematoma expansion (HE), and functional outcome in patients presenting with intracerebral hemorrhage (ICH) through a systematic review and meta-analysis.MethodsWe searched PubMed for English-written observational studies or randomized controlled trials reporting data on NCCT markers of HE and outcome in spontaneous ICH including at least 50 subjects. The outcomes of interest were HE (hematoma growth >33%, >33% and/or >6 mL, >33% and/or >12.5 mL), poor functional outcome (modified Rankin Scale 3–6 or 4–6) at discharge or at 90 days, and mortality. We pooled data in random-effects models and extracted cumulative odds ratio (OR) for each NCCT marker.ResultsWe included 25 eligible studies (n = 10,650). The following markers were associated with increased risk of HE and poor outcome, respectively: black hole sign (OR = 3.70, 95% confidence interval [CI] = 1.42–9.64 and OR = 5.26, 95% CI = 1.75–15.76), swirl sign (OR = 3.33, 95% CI = 2.42–4.60 and OR = 3.70; 95% CI = 2.47–5.55), heterogeneous density (OR = 2.74; 95% CI = 1.71–4.39 and OR = 2.80; 95% CI = 1.78–4.39), blend sign (OR = 3.49; 95% CI = 2.20–5.55 and OR = 2.21; 95% CI 1.16–4.18), hypodensities (OR = 3.47; 95% CI = 2.18–5.50 and OR = 2.94; 95% CI = 2.28–3.78), irregular shape (OR = 2.01, 95% CI = 1.27–3.19 and OR = 3.43; 95% CI = 2.33–5.03), and island sign (OR = 7.87, 95% CI = 2.17–28.47 and OR = 6.05, 95% CI = 4.44–8.24).ConclusionOur results suggest that multiple NCCT ICH shape and density features, with different effect size, are important markers for HE and clinical outcome and may provide useful information for future randomized controlled trials.

Abstract TP341: Outcomes of Obese Patients With Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ifeanyi Iwuchukwu ◽  
Jessica A Ryder ◽  
Bethany Jennings ◽  
Philip Feliciano ◽  
Doan Nguyen ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Systolic Pressure ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Hematoma Expansion ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Obese Patients ◽  
Poor Outcome ◽  
Imaging Characteristics

Introduction: Obesity is a known risk factor for cardiovascular disease and stroke. However, an obesity paradox - improved outcomes in obese patients, has been reported in coronary artery disease, cardiac surgery and ischemic stroke. We report a possible obesity paradox in patients with intracerebral hemorrhage (ICH). Methods: We retrospectively reviewed our prospectively collected database of patients diagnosed with ICH in our institution between November 2012 and March 2016. Trauma, malignancy, postoperative, vascular malformations associated hemorrhages and hemorrhagic conversion of ischemic strokes were excluded. Demographics, clinical, laboratory and imaging characteristics were collected. We defined obesity as body mass index (BMI) >30kg/m 2 ; overweight 25-29.9kg/m 2 ; normal weight 18.5-24.9kg/m 2 and underweight <18.5kg/m 2 . Poor outcome was defined by hematoma expansion >30% increase in ICH volume or discharge to nursing home, long-term acute facility or death (‘poor-discharge’). Continuous variables were analyzed using an analysis of variance and a fisher exact test or chi-square test for categorical variables. A p value <0.05 was set for significance. Results: 429 patients met criteria for our study. 50.1% were female, median age 64 years (SD 15.6) and BMI 27.4 (SD 7.9). There were 16 (3.7%) underweight; 131 (30.8%) normal weight; 138 (32.2%) overweight and 144 (33.6%) obese patients. Bivariate analysis across groups showed female gender (75% vs 56.5% vs 57% vs 50% p=0.015), diabetes mellitus (13.3% vs 20.6% vs 32.1% vs 33.3% p=0.041), systolic pressure (SBP) (177.5 vs 168 vs 175 vs 185 p=0.003), HbA1c (5.7 vs 5.9 vs 6.2 vs 6.5 p=0.0002), discharge poor outcome (43.8% vs 54.2% vs 55.8% vs 36.8% p=0.005) were significant. There was no difference in ICH volume and hematoma expansion. On multivariate analysis, only age (OR 1.02, CI 1.01 - 1.04 p=0.0004) SBP ≥ 140mmhg (OR 0.49, CI0.25 - 0.95, p=0.035) Admission glucose ≥180 (OR 2.71, CI 1.58 - 4.4.67 p=0.0003) and BMI >30kg/m 2 (OR 0.5, CI 0.29 - 0.87 p= 0.014) remained independent predictors of poor outcome. Conclusion: In our cohort, obese patients were more likely to have a good outcome suggesting the presence of an obesity paradox in outcome following intracerebral hemorrhage.

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