BACKGROUND: Uncertainty surrounds the effects of cerebral edema on outcomes in intracerebral hemorrhage (ICH). METHODS: We used data from the INTERACT trial to determine the predictors and prognostic significance of "perihematomal" edema over 72 hours after ICH. INTERACT included 404 patients with CT-confirmed ICH and elevated systolic blood pressure (BP) (150-220 mm Hg) who had the capacity to commence BP lowering treatment within 6 hours of ICH. Baseline and repeat CT (24 and 72 hours) were performed using standardized techniques, with digital images analyzed centrally. Predictors of growth in edema were determined using generalized estimating equations, and its effects on clinical outcomes were estimated using a logistic regression model. RESULTS: Overall, 270 patients had 3 sequential CT scans available for analyses. At baseline, there was a highly significant correlation between hematoma and perihematomal edema volumes (r(2) = 0.45). Lower systolic BP and baseline hematoma volume were independently associated with absolute increase in perihematomal edema volume. History of hypertension, baseline hematoma volume, and earlier time from onset to CT were independently associated with relative increase in edema volume. Both absolute and relative increases in perihematomal edema growth were significantly associated with death or dependency at 90 days after adjustment for age, gender, and randomized treatment, but not when additionally adjusted for baseline hematoma volume. CONCLUSIONS: The degree of, and growth in, perihematomal edema are strongly related to the size of the underlying hematoma of acute intracerebral hemorrhage, and do not appear to have a major independent effect in determining the outcome from this condition.
RCT Entities:
BACKGROUND: Uncertainty surrounds the effects of cerebral edema on outcomes in intracerebral hemorrhage (ICH). METHODS: We used data from the INTERACT trial to determine the predictors and prognostic significance of "perihematomal" edema over 72 hours after ICH. INTERACT included 404 patients with CT-confirmed ICH and elevated systolic blood pressure (BP) (150-220 mm Hg) who had the capacity to commence BP lowering treatment within 6 hours of ICH. Baseline and repeat CT (24 and 72 hours) were performed using standardized techniques, with digital images analyzed centrally. Predictors of growth in edema were determined using generalized estimating equations, and its effects on clinical outcomes were estimated using a logistic regression model. RESULTS: Overall, 270 patients had 3 sequential CT scans available for analyses. At baseline, there was a highly significant correlation between hematoma and perihematomal edema volumes (r(2) = 0.45). Lower systolic BP and baseline hematoma volume were independently associated with absolute increase in perihematomal edema volume. History of hypertension, baseline hematoma volume, and earlier time from onset to CT were independently associated with relative increase in edema volume. Both absolute and relative increases in perihematomal edema growth were significantly associated with death or dependency at 90 days after adjustment for age, gender, and randomized treatment, but not when additionally adjusted for baseline hematoma volume. CONCLUSIONS: The degree of, and growth in, perihematomal edema are strongly related to the size of the underlying hematoma of acute intracerebral hemorrhage, and do not appear to have a major independent effect in determining the outcome from this condition.
Authors: James M Gebel; Edward C Jauch; Thomas G Brott; Jane Khoury; Laura Sauerbeck; Shelia Salisbury; Judith Spilker; Thomas A Tomsick; John Duldner; Joseph P Broderick Journal: Stroke Date: 2002-11 Impact factor: 7.914
Authors: T Brott; H P Adams; C P Olinger; J R Marler; W G Barsan; J Biller; J Spilker; R Holleran; R Eberle; V Hertzberg Journal: Stroke Date: 1989-07 Impact factor: 7.914
Authors: Craig S Anderson; Yining Huang; Ji Guang Wang; Hisatomi Arima; Bruce Neal; Bin Peng; Emma Heeley; Christian Skulina; Mark W Parsons; Jong Sung Kim; Qing Ling Tao; Yue Chun Li; Jian Dong Jiang; Li Wen Tai; Jin Li Zhang; En Xu; Yan Cheng; Stephane Heritier; Lewis B Morgenstern; John Chalmers Journal: Lancet Neurol Date: 2008-04-07 Impact factor: 44.182
Authors: K R Wagner; G Xi; Y Hua; M Kleinholz; G M de Courten-Myers; R E Myers; J P Broderick; T G Brott Journal: Stroke Date: 1996-03 Impact factor: 7.914
Authors: Santosh B Murthy; Sebastian Urday; Lauren A Beslow; Jesse Dawson; Kennedy Lees; W Taylor Kimberly; Costantino Iadecola; Hooman Kamel; Daniel F Hanley; Kevin N Sheth; Wendy C Ziai Journal: J Neurol Neurosurg Psychiatry Date: 2016-07-27 Impact factor: 10.154