Association between Computed Tomographic Biomarkers of Cerebral Small Vessel Diseases and Long-Term Outcome after Spontaneous Intracerebral Hemorrhage.

Mark A Rodrigues,Joanna M Wardlaw,Luke A Perry,Neshika E Samarasekera,Rustam Al‐Shahi Salman,James J.M Loan,Tom J Moullaali,Christine Lerpiniere

doi:10.1002/ana.25949

Abstract

ObjectiveA study was undertaken to assess whether cerebral small vessel disease (SVD) computed tomographic (CT) biomarkers are associated with long‐term outcome after intracerebral hemorrhage.MethodsWe performed a prospective, community‐based cohort study of adults diagnosed with spontaneous intracerebral hemorrhage between June 1, 2010 and May 31, 2013. A neuroradiologist rated the diagnostic brain CT for acute intracerebral hemorrhage features and SVD biomarkers. We used severity of white matter lucencies and cerebral atrophy, and the number of lacunes to calculate the CT SVD score. We assessed the association between CT SVD biomarkers and either death, or death or dependence (modified Rankin Scale scores = 4–6) 1 year after first‐ever intracerebral hemorrhage using logistic regression, adjusting for known predictors of outcome.ResultsWithin 1 year of intracerebral hemorrhage, 224 (56%) of 402 patients died. In separate models, 1‐year death was associated with severe atrophy (adjusted odds ratio [aOR] = 2.54, 95% confidence interval [CI] = 1.44–4.49, p = 0.001) but not lacunes or severe white matter lucencies, and CT SVD sum score ≥ 1 (aOR = 2.50, 95% CI = 1.40–4.45, p = 0.002). Two hundred seventy‐seven (73%) of 378 patients with modified Rankin Scale data were dead or dependent at 1 year. In separate models, 1‐year death or dependence was associated with severe atrophy (aOR = 3.67, 95% CI = 1.71–7.89, p = 0.001) and severe white matter lucencies (aOR = 2.18, 95% CI = 1.06–4.51, p = 0.035) but not lacunes, and CT SVD sum score ≥ 1 (aOR = 2.81, 95% CI = 1.45–5.46, p = 0.002).InterpretationSVD biomarkers on the diagnostic brain CT are associated with 1‐year death and dependence after intracerebral hemorrhage, independent of known predictors of outcome. ANN NEUROL 2021;89:266–279

Highlights

The direction and magnitude of the nonsignificant association were similar to deep intracerebral hemorrhage (ICH). This prospective, community-based cohort study has shown that some computed tomographic (CT) biomarkers of small vessel disease (SVD), both individually and as part of the CT SVD score, are independently associated with 1-year death and death or dependence following first-ever SVD-ICH
In line with previous studies, we found that increasing age and decreasing admission GCS score, as well as features of the acute ICH, such as increasing ICH volume and the presence of intraventricular hemorrhage, were independently associated with death and functional outcome at 1 year after SVD-ICH.[3]
Baseline SVD markers on both CT and magnetic resonance imaging (MRI) of the brain are associated with worse prognosis after stroke, individually and when combined as composite scores.[11,12,19]

Summary

Objective

A study was undertaken to assess whether cerebral small vessel disease (SVD) computed tomographic (CT) biomarkers are associated with long-term outcome after intracerebral hemorrhage. White matter lucencies (WMLs) on brain computed tomography (CT) were associated with poor 28- and 90-day functional outcome and 90-day death after SVD-ICH in a recent meta-analysis of 9 studies, which may have been affected by selection bias.[13] Less is known about the association of WMLs and other individual CT SVD biomarkers (such as lacunes and cerebral atrophy14–16) with longer-term outcomes after SVD-ICH. We aimed to assess the associations of SVD biomarkers on the first brain CT to diagnose spontaneous ICH—individually and as a composite CT SVD score— with 1-year death or dependence after first-ever SVD-ICH in a prospective, community-based cohort study

Patients and Methods

Results

Discussion