Ultraearly Hematoma Growth in Acute Spontaneous Intracerebral Hemorrhage Predicts Early and Long-Term Poor Clinical Outcomes: A Prospective, Observational Cohort Study.

Wen-Juan Wang,Li-Ping Liu,Jing-Jing Lu,Xing-Quan Zhao,Jiao-Kun Jia

doi:10.3389/fneur.2021.747551

Wen-Juan Wang, Li-Ping Liu + Show 3 more

Open Access

https://doi.org/10.3389/fneur.2021.747551

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Abstract

Aims: Although prognostic importance of ultraearly hematoma growth (uHG) in acute, non-traumatic intracerebral hemorrhage (ICH) has been established for early outcomes, longer-term clinical outcomes are lacking. We aimed to determine the association of uHG with early and 1-year clinical outcomes after acute ICH in a larger and broader range of patients.Methods: We studied 589 patients with acute (<6 h) spontaneous ICH. uHG was defined as baseline ICH volume/onset-to-imaging time (OIT) (ml/h). Multivariable logistic regression analyses were performed to determine the association of uHG with in-hospital mortality, 90-day, and 1-year poor outcome [3 ≤ modified Rankin Scale (mRS)] after ICH.Results: The median speed of uHG was 4.8 ml/h. uHG > 9.3 ml/h was independently related to in-hospital mortality [odds ratio (OR) 2.81, 95% CI 1.52–5.23], 90-day poor outcome (OR 3.34, 95% CI 1.87–5.95), and 1-year poor outcome (OR 3.59, 95% CI 2.01–6.40) after ICH. The sensitivity of uHG > 9.3 ml/h in the prediction of in-hospital mortality, 90-day poor outcome, and 1-year poor outcome was 68.8, 48.0, and 51.1%, respectively.Conclusions: Ultraearly hematoma growth was a useful predictor of in-hospital mortality, 90-day, and 1-year poor outcome after acute ICH. The combination of both uHG and baseline ICH volume could allow better selection of patients with ICH at high risk of poorest clinical outcomes for future clinical trials to improve early- and long-term clinical outcomes.

Highlights

The incidence and the case fatality of spontaneous intracerebral hemorrhage (ICH) have not decreased and only 12–39% of the survivors live independently 6 months post-ICH onset [1]
The frequency of in-hospital mortality, 90-day, and 1-year poor outcome after acute ICH was higher in patients with Ultraearly hematoma growth (uHG) > 9.3 ml/h than in patients with uHG ≤ 9.3 ml/h (Figure 3)
The simultaneous maximum sensitivity and specificity for baseline ICH volume in predicting the primary outcome were 16 ml. Both uHG > 9.3 ml/h and baseline ICH volume > 16 ml were independently related to mortality in hospital, the poor outcome at 90 days, and 1 year in separate multivariate models adjusted for age, sex, anticoagulant use, antiplatelet use, baseline systolic blood pressure (SBP), INR, glucose level, baseline National Institutes of Health Stroke Scale (NIHSS), baseline Glasgow coma scale (GCS), ICH location, and intraventricular extension (IVE) (Table 2)