Rate of Perihematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage

Urday, Sebastian; Beslow, Lauren A.; Dai, Feng; Zhang, Fan; Battey, Thomas W.K.; Vashkevich, Anastasia; Ayres, Alison; Leasure, Audrey C; Selim, Magdy; Simard, J. Marc; Rosand, Jonathan; Kimberly, W. Taylor; Sheth, Kevin N

doi:10.1097/ccm.0000000000001553

Cited by 79 publications

(107 citation statements)

References 32 publications

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“…7 In a single-centre cohort in which participants with significant intraventricular haemorrhage and warfarin-related ICH were excluded, we reported that PHE growth rate at 24 hours was independently associated with death or disability. 8 However, at 72 hours, PHE growth rate correlated with functional outcome but not with mortality. 8 This may have been due to the small sample size of the study that limited the power to detect a significant association.…”

Section: Introductionmentioning

confidence: 94%

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Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Murthy

Urday

Beslow

et al. 2016

J Neurol Neurosurg Psychiatry

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Background Perihaematomal oedema (PHE) expansion rate may be a predictor of outcome after intracerebral haemorrhage (ICH). We determined whether PHE expansion rate in the first 72 hours after ICH predicts outcome, and how it compares against other PHE measures. Methods We included patients from the Virtual International Stroke Trials Archive. We calculated PHE expansion rate using the equation: (PHE at 72 hours- PHE at baseline)/(Time to 72 hour computerized tomography scan – Time to baseline computerized tomography scan). Outcomes of interest were mortality and poor 90-day outcome (modified Rankin Scale score of ≥ 3). Logistic regression was used to assess relationships with outcome. Results A total of 596 patients with ICH were included. At baseline, median haematoma volume was 15.0 mL (IQR: 7.9–29.2) with median PHE volume of 8.7 mL (IQR: 4.5–15.5). Median PHE expansion rate was 0.31 mL/hr (IQR: 0.12–0.55). The odds of mortality were greater with increasing PHE expansion rate (OR: 2.63, CI: 1.10–6.25), while the odds of poor outcome also increased with greater PHE growth (OR: 1.67, CI: 1.28–2.39). Female sex had an inverse relationship with PHE growth, but baseline hematoma volume had a direct correlation. Among other PHE measures, only interval increase in PHE correlated with poor outcome. There was no significant difference between the two measures of PHE volume expansion. Conclusions Rate of PHE growth over 72 hours was an independent predictor of mortality and poor functional outcomes following intracerebral haemorrhage. Baseline haematoma volume and gender appear to influence PHE growth.

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Section: Introductionmentioning

confidence: 94%

“…8 However, at 72 hours, PHE growth rate correlated with functional outcome but not with mortality. 8 This may have been due to the small sample size of the study that limited the power to detect a significant association. These results need to be replicated in a large multicentre cohort that has greater external validity.…”

Section: Introductionmentioning

confidence: 94%

Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Murthy

Urday

Beslow

et al. 2016

J Neurol Neurosurg Psychiatry

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“…Recent work has demonstrated an accurate and reproducible method for measuring PHE from computed tomography (CT) [10], as well as evidence that PHE expansion rate from admission to 24 or 72 hours post-ICH independently predicts 90-day mortality and functional outcome [11]. The objective of this analysis was to determine whether PHE expansion rate is associated with outcome for both deep and lobar ICH and, if so, whether its effect varies depending on the site of hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Perihematomal Edema Expansion Rates and Patient Outcomes in Deep and Lobar Intracerebral Hemorrhage

et al. 2016

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Background and Purpose Perihematomal edema (PHE) expansion rate may predict functional outcome following spontaneous intracerebral hemorrhage (ICH). We hypothesized that the effect of PHE expansion rate on outcome is greater for deep versus lobar ICH. Methods Subjects (n=115) were retrospectively identified from a prospective ICH cohort enrolled from 2000–2013. Inclusion criteria were age ≥18 years, spontaneous supratentorial ICH, and known onset time. Exclusion criteria were primary intraventricular hemorrhage (IVH), trauma, subsequent surgery, or warfarin-related ICH. ICH and PHE volumes were measured from CT scans and used to calculate expansion rates. Logistic regression assessed the association between PHE expansion rates and 90-day mortality or poor functional outcome (modified Rankin Scale >2). Odds ratios are per 0.04 mL/h. Results PHE expansion rate from baseline to 24 hours (PHE24) was associated with mortality for deep (p=0.03, OR 1.13[1.02–1.26]) and lobar ICH (p=0.02, OR 1.03[1.00–1.06]) in unadjusted regression, and in models adjusted for age (deep: p=0.02, OR 1.15[1.02–1.28]; lobar: p=0.03, OR 1.03[1.00–1.06]), Glasgow Coma Scale (deep: p=0.03, OR 1.13[1.01–1.27]; lobar: p=0.02, OR 1.03[1.01–1.06]), or time to baseline CT (deep: p=0.046, OR 1.12[1.00–1.25]; lobar: p=0.047, OR 1.03[1.00–1.06]). PHE expansion rate from baseline to 72 hours (PHE72) was associated with mRS>2 for deep ICH in models that were unadjusted (p=0.02, OR 4.04[1.25–13.04]) or adjusted for ICH volume (p=0.02, OR 4.3[1.25–14.98]), age (p=0.03, OR 5.4[1.21–24.11]), GCS (p=0.02, OR 4.19[1.2–14.55]), or time to first CT (p=0.03, OR 4.02[1.19–13.56]). Conclusions PHE72 was associated with poor functional outcomes after deep ICH, whereas PHE24 was associated with mortality for deep and lobar ICH.

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“…In a recent study, rate of perihematomal edema expansion at 24 hours predicted a higher mortality (odds ratio 2.97) and poor modified Rankin Scale scores (odds ratio 2.21) at 90 days. 11 Intensive BP lowering within the first 24 hours after the onset of ICH has been shown to reduce cerebral edema and perihematomal edema, leading to better outcomes. 12 First day mean arterial pressure (MAP) is directly linked to the chance of survival.…”

Section: Effects Of Hypertension On Acute Ichmentioning

confidence: 99%

Hypertension and Hemorrhagic Stroke

Kumar¹

2017

Hypertension Journal

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Hemorrhagic strokes are common and account for 20 to 30% of all strokes in India and the rest of Asia. Patients admitted with intracerebral hemorrhage (ICH) are usually sicker, and ICH is associated with worse outcomes (as compared with ischemic strokes). Hypertension is the commonest risk factor for spontaneous ICH, responsible for up to 80% of all cases of ICH, either alone or in combination with other etiological factors. Elevated blood pressure (BP) during the first few hours to days after ICH leads to worse outcomes (higher death and disability rates). This is because high BP is directly linked to hematoma expansion and increased mass effect. Therefore, rapid lowering of BP is recommended if systolic BP > 160 mm Hg. Intravenous labetalol and nicardipine are both equally safe and effective for this purpose. Survivors of ICH have a higher risk of developing recurrence of ICH both over the short term and over the long term. Aggressive BP lowering is recommended in ICH survivors postdischarge from the hospital. The target BP of <130/80 mm Hg should be maintained in them to reduce the risk of ICH recurrence.

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Rate of Perihematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage

Cited by 79 publications

References 32 publications

Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Perihematomal Edema Expansion Rates and Patient Outcomes in Deep and Lobar Intracerebral Hemorrhage

Hypertension and Hemorrhagic Stroke

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