Xia Wang1, Hisatomi Arima1, Rustam Al-Shahi Salman1, Mark Woodward1, Emma Heeley1, Christian Stapf1, Pablo M Lavados1, Thompson Robinson1, Yining Huang1, Jiguang Wang1, Candice Delcourt1, Craig S Anderson2. 1. From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.). 2. From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.). canderson@georgeinstitute.org.au.
Abstract
BACKGROUND AND PURPOSE: We developed and validated a simple algorithm to predict the risk of hematoma growth in acute spontaneous intracerebral hemorrhage (ICH) to better inform clinicians and researchers in their efforts to improve outcomes for patients. METHODS: We analyzed data from the computed tomography substudies of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and 2, respectively). The study group was divided into a derivation cohort (INTERACT2, n=964) and a validation cohort (INTERACT1, n=346). Multivariable logistic regression was used to identify factors associated with clinically significant (≥6 mL) increase in hematoma volume at 24 hours after symptom onset. A parsimonious risk score was developed on the basis of regression coefficients derived from the logistic model. RESULTS: A 24-point BRAIN score was derived from INTERACT2 (C-statistic, 0.73) based on baseline ICH volume (mL per score, ≤10=0, 10-20=5, >20=7), recurrent ICH (yes=4), anticoagulation with warfarin at symptom onset (yes=6), intraventricular extension (yes=2), and number of hours to baseline computed tomography from symptom onset (≤1=5, 1-2=4, 2-3=3, 3-4=2, 4-5=1, >5=0) predicted the probability of ICH growth (ranging from 3.4% for 0 point to 85.8% for 24 points) with good discrimination (C-statistic, 0.73) and calibration (Hosmer-Lemeshow P=0.82) in INTERACT1. CONCLUSIONS: The simple BRAIN score predicts the probability of hematoma growth in ICH. This could be used to improve risk stratification for research and clinical practice. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.
BACKGROUND AND PURPOSE: We developed and validated a simple algorithm to predict the risk of hematoma growth in acute spontaneous intracerebral hemorrhage (ICH) to better inform clinicians and researchers in their efforts to improve outcomes for patients. METHODS: We analyzed data from the computed tomography substudies of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and 2, respectively). The study group was divided into a derivation cohort (INTERACT2, n=964) and a validation cohort (INTERACT1, n=346). Multivariable logistic regression was used to identify factors associated with clinically significant (≥6 mL) increase in hematoma volume at 24 hours after symptom onset. A parsimonious risk score was developed on the basis of regression coefficients derived from the logistic model. RESULTS: A 24-point BRAIN score was derived from INTERACT2 (C-statistic, 0.73) based on baseline ICH volume (mL per score, ≤10=0, 10-20=5, >20=7), recurrent ICH (yes=4), anticoagulation with warfarin at symptom onset (yes=6), intraventricular extension (yes=2), and number of hours to baseline computed tomography from symptom onset (≤1=5, 1-2=4, 2-3=3, 3-4=2, 4-5=1, >5=0) predicted the probability of ICH growth (ranging from 3.4% for 0 point to 85.8% for 24 points) with good discrimination (C-statistic, 0.73) and calibration (Hosmer-Lemeshow P=0.82) in INTERACT1. CONCLUSIONS: The simple BRAIN score predicts the probability of hematoma growth in ICH. This could be used to improve risk stratification for research and clinical practice. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.
Authors: Gregoire Boulouis; Andrea Morotti; H Bart Brouwers; Andreas Charidimou; Michael J Jessel; Eitan Auriel; Octávio Pontes-Neto; Alison Ayres; Anastasia Vashkevich; Kristin M Schwab; Jonathan Rosand; Anand Viswanathan; Mahmut E Gurol; Steven M Greenberg; Joshua N Goldstein Journal: JAMA Neurol Date: 2016-08-01 Impact factor: 18.302
Authors: Katja E Wartenberg; Xia Wang; Paula Muñoz-Venturelli; Alejandro A Rabinstein; Pablo M Lavados; Craig S Anderson; Thompson Robinson Journal: Neurocrit Care Date: 2017-06 Impact factor: 3.210
Authors: Andrea Morotti; Dar Dowlatshahi; Gregoire Boulouis; Fahad Al-Ajlan; Andrew M Demchuk; Richard I Aviv; Liyang Yu; Kristin Schwab; Javier M Romero; M Edip Gurol; Anand Viswanathan; Christopher D Anderson; Yuchiao Chang; Steven M Greenberg; Adnan I Qureshi; Jonathan Rosand; Joshua N Goldstein Journal: Stroke Date: 2018-04-18 Impact factor: 7.914
Authors: Jia Xu Lim; Julian Xinguang Han; Angela An Qi See; Voon Hao Lew; Wan Ting Chock; Vin Fei Ban; Sohil Pothiawala; Winston Eng Hoe Lim; Louis Elliot McAdory; Michael Lucas James; Nicolas Kon Kam King Journal: Neurocrit Care Date: 2019-04 Impact factor: 3.210
Authors: Dar Dowlatshahi; H Bart Brouwers; Andrew M Demchuk; Michael D Hill; Richard I Aviv; Lee-Anne Ufholz; Michael Reaume; Max Wintermark; J Claude Hemphill; Yasuo Murai; Yongjun Wang; Xingquan Zhao; Yilong Wang; Na Li; Takatoshi Sorimachi; Mitsunori Matsumae; Thorsten Steiner; Timolaos Rizos; Steven M Greenberg; Javier M Romero; Jonathan Rosand; Joshua N Goldstein; Mukul Sharma Journal: Stroke Date: 2016-02-04 Impact factor: 7.914