Abstract
BackgroundHospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume.AimsIn a community-based study, we aimed to investigate the existence, strength, direction, and independence of associations between intracerebral hemorrhage and peri-hematomal edema volumes on diagnostic brain CT and one-year functional outcome and long-term survival.MethodsWe identified all adults, resident in Lothian, diagnosed with first-ever, symptomatic spontaneous intracerebral hemorrhage between June 2010 and May 2013 in a community-based, prospective inception cohort study. We defined regions of interest manually and used a semi-automated approach to measure intracerebral hemorrhage volume, peri-hematomal edema volume, and the sum of these measurements (total lesion volume) on first diagnostic brain CT performed at ≤3 days after symptom onset. The primary outcome was death or dependence (scores 3–6 on the modified Rankin Scale) at one-year after intracerebral hemorrhage.ResultsTwo hundred ninety-two (85%) of 342 patients (median age 77.5 y, IQR 68–83, 186 (54%) female, median time from onset to CT 6.5 h (IQR 2.9–21.7)) were dead or dependent one year after intracerebral hemorrhage. Peri-hematomal edema and intracerebral hemorrhage volumes were colinear (R2 = 0.77). In models using both intracerebral hemorrhage and peri-hematomal edema, 10 mL increments in intracerebral hemorrhage (adjusted odds ratio (aOR) 1.72 (95% CI 1.08–2.87); p = 0.029) but not peri-hematomal edema volume (aOR 0.92 (0.63–1.45); p = 0.69) were independently associated with one-year death or dependence. 10 mL increments in total lesion volume were independently associated with one-year death or dependence (aOR 1.24 (1.11–1.42); p = 0.0004).ConclusionTotal volume of intracerebral hemorrhage and peri-hematomal edema, and intracerebral hemorrhage volume alone on diagnostic brain CT, undertaken at three days or sooner, are independently associated with death or dependence one-year after intracerebral hemorrhage, but peri-hematomal edema volume is not.Data access statementAnonymized summary data may be requested from the corresponding author.
Highlights
Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume
Community-based cohort study of patients scanned in a median time of 6 h after intracerebral hemorrhage (ICH) symptom onset, we did not find evidence of an association between any measure of baseline Peri-hematomal edema (PHE) volume with functional outcome that was independent of ICH volume, because ICH volume and measures of PHE were collinear
Of four previous studies which have examined the association between PHE at baseline and poor outcome after ICH using multivariable analyses to adjust for ICH volume and other confounders, two found an association (1337 and 10613 patients), one did not find an association (596 patients)[12] and one other (98 patients) found that greater relative PHE—the ratio of PHE:ICH volume—was associated with better survival at 90 days.[11]
Summary
Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume. Eighty-six percent of patients are dead or dependent within one year of a spontaneous (non-traumatic) intracerebral hemorrhage (ICH).[1] Established predictors of poor outcome after ICH include greater baseline ICH volume, older age at onset, infratentorial location, and intraventricular extension.[2,3] Peri-hematomal edema (PHE) is a radiological abnormality observed after ICH which occupies a variable volume.[4,5]. Within the first week of ICH onset, PHE manifests on CT brain scans as peri-hematomal hypoattenuation. The association between PHE on diagnostic brain CT and outcome is unclear. Of 16 cohort studies examining this association, all were hospital-based, 5 studies recruited participants prospectively,[6,7,8,9,10] and only 4 studies adjusted for potential confounders.[7,11,12,13]
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