Abstract TP430: Early Neurological Improvement and Deterioration in Patients With Primary Intracerebral Hemorrhage Predicts 90-Day Functional Outcome: Analysis From ATACH-2 Trial

Abstract

Background: The significance of early neurological improvement (ENI) and deterioration (END) in patients with primary intracerebral hemorrhage (ICH) is unclear. We sought to determine the prevalence and predictors of ENI and END and their impact on long term clinical outcome in patients with primary ICH recruited within 4.5 hours after symptom onset. Methods: We analyzed data from Antihypertensive Treatment at Acute Cerebral Hemorrhage (ATACH)-2 trial. ENI and END were defined by ≥ 4 points decrease or increase in NIHSS score within 24 hours post randomization, respectively. Baseline characteristics of patients that predicted ENI and END were identified. The association between ENI and END with favorable 90-day outcome (defined as modified Rankin Scale (mRS) <2) was analyzed after adjustment for potential confounders. Results: Ninety five of 1000 patients with ICH had END (9.5%). END was more common among non-Asians compared to Asians (55% vs 42%), patients with hematoma volume >=30 cc (26% vs 8%, p=<.0001) and intraventricular hemorrhage (IVH) (41% vs 25%, p=0.0015). Similarly, patients with END had higher baseline NIHSS score (median value 14 vs 10, p=<.0001). Patients with END had significantly lower rate of favorable 90-day outcome (6% vs 28%, p=<.0001). ENI was seen in 165 (19%) of patients. ENI was associated with lower initial Glasgow Coma Scale (GCS) score, lack of IVH, basal ganglia hematoma, and prior antihypertensive treatment. Patients with ENI had significantly higher chance of favorable 90-day outcome (29% vs 20%, p=0.019). In multivariate models that adjusted for initial GCS score, age and presence of IVH, both ENI and END were independent predictors of 90-day favorable outcome with (RR=1.40; 95% CI: 1.00, 1.97) and (RR=0.26; 95% CI: 0.11, 0.63), respectively. IVH and GCS score were independent predictors of early neurological changes. Conclusions: We found a relatively high prevalence of early neurological improvement or deterioration in ICH patients. Both ENI and END are independent predictors of 90-day functional outcome.