Delayed perihematomal hypoperfusion is associated with poor outcome in intracerebral haemorrhage

Abstract

Background The aim of this study was to characterize the temporal evolution and prognostic significance of perihematomal perfusion in acute intracerebral haemorrhage (ICH). Methods A single‐centre prospective cohort of patients with primary spontaneous ICH receives computed tomography perfusion (CTP) within 6 h from onset (T0) and at 7 days (T7). Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the manually outlined perihematomal low‐density area. Poor functional prognosis (modified Rankin Scale 3–6) at 90 days was the outcome of interest, and predictors were explored with multivariable logistic regression. Results A total of 150 patients were studied, of whom 52 (34.7%) had a mRS 3–6 at 90 days. Perihematomal perfusion decreased from T0 to T7 in all patients, but the magnitude of CBF and CBV reduction was larger in patients with unfavourable outcome (median CBF change −7.8 vs. −6.0 ml/100 g/min, p < .001, and median CBV change −0.5 vs. −0.4 ml/100 g, p = .010, respectively). This finding remained significant after adjustment for confounders (odds ratio [OR] for 1 ml/100 g/min CBF reduction: 1.33, 95% confidence interval [CI] (1.15–1.55), p < .001; OR for 0.1 ml/100 g CBV reduction: 1.67, 95% CI 1.18–2.35, p = .004). The presence of CBF < 20 ml/100 g/min at T7 was then demonstrated as an independent predictor of poor functional outcome (adjusted OR: 2.45, 95% CI 1.08–5–54, p = .032). Conclusion Perihaemorrhagic hypoperfusion becomes more severe in the days following acute ICH and is independently associated with poorer outcome. Understanding the underlying biological mechanisms responsible for delayed decrease in perihematomal perfusion is a necessary step towards outcome improvement in patients with ICH.

Elevated blood urea nitrogen to creatinine ratio during hospitalization is associated with 90-day poor outcome in ICH patients

“…Studies on the relationship between dehydration and ischemic stroke prognosis suggest that dehydration leads to poor prognosis by reducing cerebral perfusion, especially the maintenance of cerebral perfusion during critical periods of brain recovery after stroke [17] . Perihematoma hypoperfusion after ICH has been frequently reported, especially delayed perihematomas hypoperfusion after 1 week from onset [28][29][30] , and it has been confirmed to be associated with poor outcome in ICH [31][32] . We hypothesize that dehydration at admission in ICH patients reduces the risk of mortality and has no relationship with functional outcome, but dehydration after admission may aggravate perihematoma hypoperfusion and then leads to poor long-term functional outcome.…”

The effect of blood pressure variability on the prognosis of patients with acute cerebral hemorrhage: Possible mechanism

“…In addition, the above studies were limited to the hyperacute phase. Regarding sustained blood pressure reduction, a recent study by Morotti et al (2022) showed that cerebral perfusion around the hematoma gradually decreased with the development of the disease, and 7-day CBF < 20 ml/100 g/min was shown to be an independent predictor of poor functional outcome (OR: 2.45, 95% CI 1.08-5-54, p = 0.032).…”