Santosh B Murthy1, Yogesh Moradiya2, Jesse Dawson2, Kennedy R Lees2, Daniel F Hanley2, Wendy C Ziai2. 1. From the Division of Neurosciences Critical Care, Department of Neurology (S.B.M., Y.M., W.C.Z.) and Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cerebrovascular Medicine, University of Glasgow, United Kingdom (J.D., K.R.L.). santoshbmurthy@gmail.com. 2. From the Division of Neurosciences Critical Care, Department of Neurology (S.B.M., Y.M., W.C.Z.) and Division of Brain Injury Outcomes (D.F.H.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Cerebrovascular Medicine, University of Glasgow, United Kingdom (J.D., K.R.L.).
Abstract
BACKGROUND AND PURPOSE: Perihematomal edema (PHE) is associated with poor outcomes after intracerebral hemorrhage (ICH). PHE evolves in the early period after ICH, providing a therapeutic target and window for intervention. We studied the effect of PHE volume expansion in the first 72 hours (iPHE) and its relationship with functional outcomes. METHODS: We used data contained in the Virtual International Stroke Trials Archive. We included patients who presented within 6 hours of symptom onset, had baseline clinical, radiological, and laboratory data, and further computed tomographic scan data at 72 hours and 90-day functional outcomes. We calculated iPHE and used logistic regression analysis to assess relationships with outcome. We adjusted for confounding variables and the primary outcome measure poor day-90 outcome (defined as modified Rankin Scale score of ≥3. We performed subgroup analyses by location and by volume of ICH. RESULTS: We included 596 patients with ICH. Median baseline hematoma volume was 15.0 mL (IQR, 7.9-29.2) and median baseline PHE volume was 8.7 mL (IQR, 4.5-15.5). Hematoma expansion occurred in 122 (34.9%) patients. Median iPHE was 14.7 mL (IQR, 6.6-30.3). The odds of a poor outcome were greater with increasing iPHE (OR, 1.78; CI, 1.12-2.64 per mL increase). Subgroup analyses showed that iPHE was only related to poor functional outcomes in basal ganglia and small (<30 mL) ICH. CONCLUSIONS: Absolute increase in PHE during 72 hours was associated with worse functional outcomes after ICH, particularly with basal ganglia ICH and hematomas <30 mL.
RCT Entities:
BACKGROUND AND PURPOSE:Perihematomal edema (PHE) is associated with poor outcomes after intracerebral hemorrhage (ICH). PHE evolves in the early period after ICH, providing a therapeutic target and window for intervention. We studied the effect of PHE volume expansion in the first 72 hours (iPHE) and its relationship with functional outcomes. METHODS: We used data contained in the Virtual International Stroke Trials Archive. We included patients who presented within 6 hours of symptom onset, had baseline clinical, radiological, and laboratory data, and further computed tomographic scan data at 72 hours and 90-day functional outcomes. We calculated iPHE and used logistic regression analysis to assess relationships with outcome. We adjusted for confounding variables and the primary outcome measure poor day-90 outcome (defined as modified Rankin Scale score of ≥3. We performed subgroup analyses by location and by volume of ICH. RESULTS: We included 596 patients with ICH. Median baseline hematoma volume was 15.0 mL (IQR, 7.9-29.2) and median baseline PHE volume was 8.7 mL (IQR, 4.5-15.5). Hematoma expansion occurred in 122 (34.9%) patients. Median iPHE was 14.7 mL (IQR, 6.6-30.3). The odds of a poor outcome were greater with increasing iPHE (OR, 1.78; CI, 1.12-2.64 per mL increase). Subgroup analyses showed that iPHE was only related to poor functional outcomes in basal ganglia and small (<30 mL) ICH. CONCLUSIONS: Absolute increase in PHE during 72 hours was associated with worse functional outcomes after ICH, particularly with basal ganglia ICH and hematomas <30 mL.
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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