Abstract WMP94: Perihematomal Edema and Functional Outcomes in Intracerebral Hemorrhage: Influence of Hematoma Volume and Location

Abstract

Background and Purpose: Perihematomal edema is associated with poor outcomes following intracerebral hemorrhage (ICH). Perihematomal edema evolves in the early period after ICH, providing a therapeutic target and window for intervention. We studied the effect of perihematomal edema volume expansion in the first 72 hours (iPHE) and its relationship with functional outcomes. Methods: We used data contained in the Virtual International Stroke Trials Archive. We included patients who presented within six-hours of symptom onset, had baseline clinical, radiological and laboratory data, and further computed tomographic scan data at 72 hours and 90-day functional outcomes. We calculated iPHE and used logistic regression analysis to assess relationships with outcome. We adjusted for confounding variables and the primary outcome measure poor day-90 outcome (defined as modified Rankin Scale score of ≥ 3. We performed subgroup analyses by location and volume of ICH. Results: We included 596 patients with ICH. Median baseline hematoma volume was 15.0 mL (IQR: 7.9- 29.2) and median baseline perihematomal edema volume of 8.7 mL (IQR: 4.5- 15.5). Hematoma expansion occured in 122 (34.9%) patients. Median iPHE was 14.7 mL (IQR: 6.6-30.3). The odds of a poor outcome were greater with increasing iPHE (OR: 1.78, CI: 1.12- 2.64 per mL increase). Subgroup analyses showed iPHE was only related to poor functional outcomes in basal ganglia and small (<30 mL) ICH. Conclusion: Absolute increase in PHE over 72 hours was associated with worse functional outcomes following ICH, particularly with basal ganglia ICH and hematomas <30 mL.