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

Abstract

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. Subjects (n=115) were retrospectively identified from a prospective ICH cohort enrolled from 2000 to 2013. Inclusion criteria were age≥18years, 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 0.04mL/h. PHE expansion rate from baseline to 24h (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 72h (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]). PHE72 was associated with poor functional outcomes after deep ICH, whereas PHE24 was associated with mortality for deep and lobar ICH.