Bastian Volbers1, Antje Giede-Jeppe2, Stefan T Gerner2, Jochen A Sembill2, Joji B Kuramatsu2, Stefan Lang2, Hannes Lücking2, Dimitre Staykov2, Hagen B Huttner2. 1. From the Neurological Department (B.V., A.G.-J., S.T.G., J.A.S., J.B.K., D.S., H.B.H.) and Neuroradiological Department (S.L., H.L.), University of Erlangen-Nuremberg, Germany; Department of Neurology (D.S.), Hospital of the Brothers of St. John, Eisenstadt, Austria; and Department of Neurology (B.V.), Inselspital, University Hospital of Bern, Switzerland. bastian.volbers@gmx.net. 2. From the Neurological Department (B.V., A.G.-J., S.T.G., J.A.S., J.B.K., D.S., H.B.H.) and Neuroradiological Department (S.L., H.L.), University of Erlangen-Nuremberg, Germany; Department of Neurology (D.S.), Hospital of the Brothers of St. John, Eisenstadt, Austria; and Department of Neurology (B.V.), Inselspital, University Hospital of Bern, Switzerland.
Abstract
OBJECTIVE: To evaluate the association of perihemorrhagic edema (PHE) evolution and peak edema extent with day 90 functional outcome in patients with intracerebral hemorrhage (ICH) and identify pathophysiologic factors influencing edema evolution. METHODS: This retrospective cohort study included patients with spontaneous supratentorial ICH between January 2006 and January 2014. ICH and PHE volumes were studied using a validated semiautomatic volumetric algorithm. Multivariable logistic regression and propensity score matching (PSM) accounting for age, ICH volume, and location were used for assessing measures associated with functional outcome and PHE evolution. Clinical outcome on day 90 was assessed using the modified Rankin Scale (0-3 = favorable, 4-6 = poor). RESULTS: A total of 292 patients were included. Median age was 70 years (interquartile range [IQR] 62-78), median ICH volume on admission 17.7 mL (IQR 7.9-40.2). Besides established factors for functional outcome, i.e., ICH volume and location, age, intraventricular hemorrhage, and NIH Stroke Scale score on admission, multivariable logistic regression revealed peak PHE volume (odds ratio [OR] 0.984 [95% confidence interval (CI) 0.973-0.994]) as an independent predictor of day 90 outcome. Peak PHE volume was independently associated with initial PHE increase up to day 3 (OR 1.060 [95% CI 1.018-1.103]) and neutrophil to lymphocyte ratio on day 6 (OR 1.236 [95% CI 1.034-1.477; PSM cohort, n = 124]). Initial PHE increase (PSM cohort, n = 224) was independently related to hematoma expansion (OR 3.647 [95% CI 1.533-8.679]) and fever burden on days 2-3 (OR 1.456 [95% CI 1.103-1.920]). CONCLUSION: Our findings suggest that peak PHE volume represents an independent predictor of functional outcome after ICH. Inflammatory processes and hematoma expansion seem to be involved in PHE evolution and may represent important treatment targets.
OBJECTIVE: To evaluate the association of perihemorrhagic edema (PHE) evolution and peak edema extent with day 90 functional outcome in patients with intracerebral hemorrhage (ICH) and identify pathophysiologic factors influencing edema evolution. METHODS: This retrospective cohort study included patients with spontaneous supratentorial ICH between January 2006 and January 2014. ICH and PHE volumes were studied using a validated semiautomatic volumetric algorithm. Multivariable logistic regression and propensity score matching (PSM) accounting for age, ICH volume, and location were used for assessing measures associated with functional outcome and PHE evolution. Clinical outcome on day 90 was assessed using the modified Rankin Scale (0-3 = favorable, 4-6 = poor). RESULTS: A total of 292 patients were included. Median age was 70 years (interquartile range [IQR] 62-78), median ICH volume on admission 17.7 mL (IQR 7.9-40.2). Besides established factors for functional outcome, i.e., ICH volume and location, age, intraventricular hemorrhage, and NIH Stroke Scale score on admission, multivariable logistic regression revealed peak PHE volume (odds ratio [OR] 0.984 [95% confidence interval (CI) 0.973-0.994]) as an independent predictor of day 90 outcome. Peak PHE volume was independently associated with initial PHE increase up to day 3 (OR 1.060 [95% CI 1.018-1.103]) and neutrophil to lymphocyte ratio on day 6 (OR 1.236 [95% CI 1.034-1.477; PSM cohort, n = 124]). Initial PHE increase (PSM cohort, n = 224) was independently related to hematoma expansion (OR 3.647 [95% CI 1.533-8.679]) and fever burden on days 2-3 (OR 1.456 [95% CI 1.103-1.920]). CONCLUSION: Our findings suggest that peak PHE volume represents an independent predictor of functional outcome after ICH. Inflammatory processes and hematoma expansion seem to be involved in PHE evolution and may represent important treatment targets.
Authors: Audrey C Leasure; Adnan I Qureshi; Santosh B Murthy; Hooman Kamel; Joshua N Goldstein; Kyle B Walsh; Daniel Woo; Fu-Dong Shi; Hagen B Huttner; Wendy C Ziai; Daniel F Hanley; Charles C Matouk; Lauren H Sansing; Guido J Falcone; Kevin N Sheth Journal: Stroke Date: 2019-07-05 Impact factor: 7.914
Authors: Robert Hurford; Andy Vail; Calvin Heal; Wendy C Ziai; Jesse Dawson; Santosh B Murthy; Xia Wang; Craig S Anderson; Daniel F Hanley; Adrian R Parry-Jones Journal: Eur Stroke J Date: 2019-05-30