Qi Li1, Rui Li2, Li-Bo Zhao3, Xiao-Min Yang4, Wen-Song Yang2, Lan Deng2, Xin-Ni Lv2, Guo-Feng Wu5, Zhou-Ping Tang6, Miao Wei7, Yi-Neng Zheng7, Fa-Jin Lv7, Xiao-Chuan Sun4, Joshua N Goldstein8, Peng Xie9. 1. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. qili_md@126.com. 2. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. 3. Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China. 2267254102@qq.com. 4. Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. 5. Emergency Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550025, China. 6. Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. 7. Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. 8. Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. 9. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. peng_xie@yahoo.com.
Abstract
BACKGROUND/ OBJECTIVES: The objective of this study is to propose a definition of intraventricular hemorrhage (IVH) growth and to investigate whether IVH growth is associated with ICH expansion and functional outcome. METHODS: We performed a prospective observational study of ICH patients between July 2011 and March 2017 in a tertiary hospital. Patients were included if they had a baseline CT scan within 6 h after onset of symptoms and a follow-up CT within 36 h. IVH growth was defined as either any newly occurring intraventricular bleeding on follow-up CT scan in patients without baseline IVH or an increase in IVH volume ≥ 1 mL on follow-up CT scan in patients with initial IVH. Poor outcome was defined as modified Rankin Scale score of 3-6 at 90 days. The association between IVH growth and functional outcome was assessed by using multivariable logistic regression analysis. RESULTS: IVH growth was observed in 59 (19.5%) of 303 patients. Patients with IVH growth had larger baseline hematoma volume, higher NIHSS score and lower GCS score than those without. Of 44 patients who had concurrent IVH growth and hematoma growth, 41 (93.2%) had poor functional outcome at 3-month follow-up. IVH growth (adjusted OR 4.15, 95% CI 1.31-13.20; P = 0.016) was an independent predictor of poor functional outcome (mRS 3-6) at 3 months in multivariable analysis. CONCLUSION: IVH growth is not uncommon and independently predicts poor outcome in ICH patients. It may serve as a promising therapeutic target for intervention.
BACKGROUND/ OBJECTIVES: The objective of this study is to propose a definition of intraventricular hemorrhage (IVH) growth and to investigate whether IVH growth is associated with ICH expansion and functional outcome. METHODS: We performed a prospective observational study of ICH patients between July 2011 and March 2017 in a tertiary hospital. Patients were included if they had a baseline CT scan within 6 h after onset of symptoms and a follow-up CT within 36 h. IVH growth was defined as either any newly occurring intraventricular bleeding on follow-up CT scan in patients without baseline IVH or an increase in IVH volume ≥ 1 mL on follow-up CT scan in patients with initial IVH. Poor outcome was defined as modified Rankin Scale score of 3-6 at 90 days. The association between IVH growth and functional outcome was assessed by using multivariable logistic regression analysis. RESULTS: IVH growth was observed in 59 (19.5%) of 303 patients. Patients with IVH growth had larger baseline hematoma volume, higher NIHSS score and lower GCS score than those without. Of 44 patients who had concurrent IVH growth and hematoma growth, 41 (93.2%) had poor functional outcome at 3-month follow-up. IVH growth (adjusted OR 4.15, 95% CI 1.31-13.20; P = 0.016) was an independent predictor of poor functional outcome (mRS 3-6) at 3 months in multivariable analysis. CONCLUSION: IVH growth is not uncommon and independently predicts poor outcome in ICH patients. It may serve as a promising therapeutic target for intervention.
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