Spontaneous Intracerebral Hemorrhage Patients Research Articles

Early postoperative acetylsalicylic acid administration does not increase the risk of postoperative intracranial bleeding in patients with spontaneous intracerebral hemorrhage.

Administration of acetylsalicylic acid (ASA) at early stage after surgery for spontaneous intracerebral hemorrhage (SICH) may increase the risk of postoperative intracranial bleeding (PIB), because of potential inhibition of platelet function. This study aimed to investigate whether early ASA administration after surgery was related to increased risk of PIB. This retrospective study enrolled SICH patients receiving surgery from September 2019 to December 2022 in seven medical institution. Based on postoperative ASA administration, patients who continuously received ASA more than three days within seven days post-surgery were identified as ASA users, otherwise as non-ASA users. The primary outcome was symptomatic PIB events within seven days after surgery. Incidence of PIB was compared between ASA users and non-ASA users using survival analysis. This study included 744 appropriate patients from 794 SICH patients. PIB occurred in 42 patients. Survival analysis showed no statistical difference between ASA users and non-ASA users in incidence of PIB (P = 0.900). Multivariate Cox analysis demonstrated current smoker (hazard ratio [HR], 2.50, 95%CI, 1.33-4.71, P = 0.005), dyslipidemia (HR = 3.03; 95%CI, 1.31-6.99; P = 0.010) and pre-hemorrhagic antiplatelet therapy (HR = 3.05; 95% CI, 1.64-5.68; P < 0.001) were associated with PIB. Subgroup analysis manifested no significant difference in incidence of PIB between ASA users and non-ASA users after controlling the effect from factors of PIB (i.e., sex, age, current smoker, regular drinker, dyslipidemia, pre-hemorrhagic antiplatelet therapy and hematoma location). This study revealed that early ASA administration to SICH patients after surgery was not related to increased risk of PIB.

307 Active Exchange of CSF for Rapid Removal of Blood in Hemorrhagic Stroke—Multicenter Experience in 40 Patients

INTRODUCTION: Spontaneous Intracerebral hemorrhage (ICH) and subarachnoidal hemorrhages (SAH) can represent with intraventricular hemorrhage (IVH). Previous studies have demonstrated, patients with IVH have higher mortality and morbidity. Neuroinflammation due to organization of blood in cerebrospinal fluid (CSF) is one of the key contributing factors to poor outcome. METHODS: Data utilizing the new active EVD system were collected from six leading centers in the EU and USA. 40 patients were analyzed, 21 patients had SAH, 13 patients had spontaneous ICH related IVH, and six patient had vascular anomaly related hemorrhage. Blood removal from ventricular system was calculated utilizing daily CT imaging. Actual and expected shunt dependency were calculated for SAH patients with CHESS score. RESULTS: Removal of blood from CSF system with the active EVD was achieved safely. Pace of blood removal was highly related to irrigation volume used during treatment. All the 13 spontaneous ICH patients had IVH clearance of median 91.3% (0.7-100%) in average 7.6 days. Additionally, in the SAH patients, there was lower shunt (2) dependency compared to those observed in literature and to expected (11) calculated based on CHESS score. Vascular anomaly cohort had median IVH clearance 91.3% in average 8.0 days. CONCLUSIONS: It is safe and feasible to remove blood from CSF system in an accelerated fashion via active EVD. Active removal of blood reduced adverse events in this patient population. Removal of blood is highly related to irrigation rate. Prospective trials are needed to demonstrate the target population who will benefit the most from CSF exchange during hemorrhagic stroke treatment.

PHE-SICH-CT-IDS: A benchmark CT image dataset for evaluation semantic segmentation, object detection and radiomic feature extraction of perihematomal edema in spontaneous intracerebral hemorrhage

Background and objective:Intracerebral hemorrhage is one of the diseases with the highest mortality and poorest prognosis worldwide. Spontaneous intracerebral hemorrhage (SICH) typically presents acutely, prompt and expedited radiological examination is crucial for diagnosis, localization, and quantification of the hemorrhage. Early detection and accurate segmentation of perihematomal edema (PHE) play a critical role in guiding appropriate clinical intervention and enhancing patient prognosis. However, the progress and assessment of computer-aided diagnostic methods for PHE segmentation and detection face challenges due to the scarcity of publicly accessible brain CT image datasets. Methods:This study establishes a publicly available CT dataset named PHE-SICH-CT-IDS for perihematomal edema in spontaneous intracerebral hemorrhage. The dataset comprises 120 brain CT scans and 7,022 CT images, along with corresponding medical information of the patients. To demonstrate its effectiveness, classical algorithms for semantic segmentation, object detection, and radiomic feature extraction are evaluated. The experimental results confirm the suitability of PHE-SICH-CT-IDS for assessing the performance of segmentation, detection and radiomic feature extraction methods. Results:This study conducts numerous experiments using classical machine learning and deep learning methods, demonstrating the differences in various segmentation and detection methods on the PHE-SICH-CT-IDS. The highest precision achieved in semantic segmentation is 76.31%, while object detection attains a maximum precision of 97.62%. The experimental results on radiomic feature extraction and analysis prove the suitability of PHE-SICH-CT-IDS for evaluating image features and highlight the predictive value of these features for the prognosis of SICH patients. Conclusion:To the best of our knowledge, this is the first publicly available dataset for PHE in SICH, comprising various data formats suitable for applications across diverse medical scenarios. We believe that PHE-SICH-CT-IDS will allure researchers to explore novel algorithms, providing valuable support for clinicians and patients in the clinical setting. PHE-SICH-CT-IDS is freely published for non-commercial purpose at https://figshare.com/articles/dataset/PHE-SICH-CT-IDS/23957937.

Independent Factors Associated with 30-Day In-Hospital Mortality from Acute Spontaneous Intracerebral Hemorrhage

ObjectiveThis study aims to investigate independent factors associated with 30-day mortality in patients with acute spontaneous intracerebral hemorrhage before treatment. MethodsA retrospective analysis was performed on medical records of patients hospitalized with acute spontaneous intracerebral hemorrhage between 2019 and 2021. Data included personal history, hospital stay duration, symptom onset, chief complaint, underlying diseases, medication, and alcohol/smoking habits. Physical examination records comprised baseline blood pressure, Glasgow Coma Scale assessment, and pupil reaction evaluation. Diagnostic imaging, specifically CT brain scans, was examined for hemorrhage details. Multivariable logistic analysis was utilized for data analysis. ResultsAmong 663 cases, 185 (27.9%) experienced mortality. Risk factors for mortality included chronic kidney disease, ischemic heart disease, loss of follow-up in hypertension clinic, and pontine hemorrhage. Conversely, motor response, reactive pupils, and basal cistern persistence significantly decreased the risk of mortality in multivariable analysis. ROC analysis identified a motor response score of 5 as the cutoff for predicting survival. ConclusionChronic kidney disease, ischemic heart disease, loss of hypertension follow-up, motor response, reactive pupils, pontine hemorrhage, and basal cistern persistence were independent variables associated with the 30-day mortality rate in spontaneous intracerebral hemorrhage patients before treatment initiation. A motor response, pupil reaction, and basal cistern persistence serve as predictive tools for assessing mortality in SICH before treatment.

Predicting hematoma expansion in acute spontaneous intracerebral hemorrhage: integrating clinical factors with a multitask deep learning model for non-contrast head CT

PurposeTo predict hematoma growth in intracerebral hemorrhage patients by combining clinical findings with non-contrast CT imaging features analyzed through deep learning.MethodsThree models were developed to predict hematoma expansion (HE) in 572 patients. We utilized multi-task learning for both hematoma segmentation and prediction of expansion: the Image-to-HE model processed hematoma slices, extracting features and computing a normalized DL score for HE prediction. The Clinical-to-HE model utilized multivariate logistic regression on clinical variables. The Integrated-to-HE model combined image-derived and clinical data. Significant clinical variables were selected using forward selection in logistic regression. The two models incorporating clinical variables were statistically validated.ResultsFor hematoma detection, the diagnostic performance of the developed multi-task model was excellent (AUC, 0.99). For expansion prediction, three models were evaluated for predicting HE. The Image-to-HE model achieved an accuracy of 67.3%, sensitivity of 81.0%, specificity of 64.0%, and an AUC of 0.76. The Clinical-to-HE model registered an accuracy of 74.8%, sensitivity of 81.0%, specificity of 73.3%, and an AUC of 0.81. The Integrated-to-HE model, merging both image and clinical data, excelled with an accuracy of 81.3%, sensitivity of 76.2%, specificity of 82.6%, and an AUC of 0.83. The Integrated-to-HE model, aligning closest to the diagonal line and indicating the highest level of calibration, showcases superior performance in predicting HE outcomes among the three models.ConclusionThe integration of clinical findings with non-contrast CT imaging features analyzed through deep learning showed the potential for improving the prediction of HE in acute spontaneous intracerebral hemorrhage patients.

Abstract WP62: Intracerebral Hemorrhage Score and Glasgow Coma Scale Are Not Accurate Predictors of Subsequent Mechanical Ventilation in Initially Non-Intubated Intracerebral Hemorrhage Patients

Introduction: Intracerebral hemorrhage (ICH) often requires mechanical ventilation (MV), increasing patient risks and hospital costs. Two standard tools were evaluated for their ability to predict patients needing subsequent MV. A predictive tool could reduce costs and complications from unnecessary MV and reduce risks for patients requiring non-elective intubation. Methods: Spontaneous ICH patients were evaluated at a comprehensive stroke center, focusing on those not intubated upon arrival or in the Emergency Department. Retrospective chart review included ICH score (ICHS), Glasgow Coma Scale (GCS), MV rates, and timing of intubation. To assess the ability of ICHS and GCS to predict subsequent MV within two weeks, we used the area under the receiver operating characteristic curve (AUC) and Youden's J statistic (range 0-1), which combines sensitivity and specificity. Higher values indicate better test performance. Results: Over 4 years, 700 consecutive ICH patients were evaluated, with 231 meeting analysis criteria. Of these, 20/231 (8.66%) received subsequent MV within the following two weeks. Neither the ICHS nor GCS accurately predicted subsequent MV, with AUC/Standard Error/Youden's J of 0.630/0.066/0.254 for ICHS and 0.643/0.070/0.235 for GCS. Specificity was &gt;97% (95% Confidence Interval: 94-99%) for both an ICHS &gt; 4 and a GCS &lt; 8; however, corresponding sensitivities were low (5% and 10%, respectively). Conclusions: The ICHS and GCS are not accurate predictors of subsequent MV, as shown by the low AUC and Youden's J. Both scales are &gt;97% specific when the ICHS is &gt; 4 or GCS is &lt; 8, which may identify high-risk patients but would overlook others. Development of an intubation-specific tool, further exploration of alternative existing ICH scores, and evaluation of a larger sample size are needed.

Abstract WMP33: Translating Evidence Into Practice: Early Supported Discharge in Intracerebral Hemorrhage

Background: The 2022 guidelines from the American Heart Association/American Stroke Association underscore the significance of coordinated multidisciplinary care and early discharge planning for spontaneous intracerebral hemorrhage (ICH) patients. Early Supported Discharge (ESD) programs have been found to curtail hospital stays for ICH patients. Purpose: This Quality Improvement initiative aimed to optimize our ESD program, originally designed for acute ischemic stroke patients, by expanding eligibility to encompass mild to moderate spontaneous ICH patients. The primary objectives were to evaluate the effects on the hospital length of stay and discharge-to-home rates. Methods: In 2020, a collaboration between our acute care hospital and homecare organization led to the development of an ESD program, Homeward Stroke Recovery, for ischemic stroke survivors in local catchment areas. Eligibility criteria were broadened to include ICH patients in July 2022. Descriptive statistics were used to track the program's performance, specifically discharge-to-home rates and hospital length of stay for ICH survivors discharged with Homeward Stroke Recovery. Results: Following the expansion of Homeward Stroke Recovery Program eligibility, the discharge-to-home rate for ICH patients at the site increased by 14.2% (27.5% to 41.7%). Additionally, the median length of stay decreased by 2 days (6 days to 4 days). Conclusions: In conclusion, our Quality Improvement project has successfully enhanced the Homeward Stroke Recovery program. This was achieved by aligning eligibility criteria with evidence-based recommendations for patients with mild to moderate spontaneous ICH, leading to a substantial positive impact on patient outcomes. The outcomes of this initiative not only affirm the efficacy of broadening eligibility for ESD programs but serves as a beacon and blueprint to widen scope through evidence-guided improvements.

Abstract 147: Novel Inflammatory and Pro-Thrombotic mRNA Pathways Associated With Worse 3-month Outcome After Intracerebral Hemorrhage

Background: Intracerebral hemorrhage (ICH) has the highest disability among stroke survivors. The Recovery and Outcomes from Stroke (ROSE) study (U01NS100417) utilized RNA sequencing (RNAseq) to identify biomarkers associated with poor outcome at 3 months. Methods: Supratentorial, non-moribund, ≥ 18 years of age, spontaneous ICH patients were prospectively recruited in a multi-center study. Whole blood was obtained at baseline (&lt;15 days; RNA PAXgene tubes, Qiagen). 3-month outcomes were determined by modified Rankin Scale (mRS) 0-3 (good) vs 4-6 (poor). RNAseq libraries were constructed using the Illumina TruSeq Stranded Total RNA kit with Ribo-Zero, sequenced on an llumina NovaSeq 6000 platform using 1 x100 bp single end reads to generate 25-30 million reads at &gt;90% &gt;Q30 reads. Differential expression was tested using DESeq2 (negative binomial), adjusting for sequencing batch, age, sex, race, ICH volume, intraventricular hemorrhage, presenting Glasgow Coma Scale, and lobar vs non-lobar location. Pathway analyses and protein-protein interactions were computed on a set of genes (P &lt; 0.0001) using STRING, Cytoscape, MCODE, and Reactome. Results: We analyzed baseline blood samples from 278 patients (N = 156 vs 122; good vs poor outcomes at 3 months). Multiple pathways were associated with poor outcome, including those involved in clot formation and cell-cell/cell-matrix interactions (not shown). The statistically most significant pathway was observed for transcripts involved in neutrophil activation and degranulation. Conclusion: Variation in mRNA expression pathways associated with inflammation, coagulation and cellular interactions were associated with poor outcome after controlling for severity measures.

Abstract WP160: Mechanisms of Brain Hemorrhage in Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is a risk factor for intracerebral hemorrhage (ICH) and for worse outcomes following ICH. In this study, we examined the relationship between ICH and CKD, as well as intracranial arterial calcification (IAC) as an intermediate biomarker. We hypothesized that CKD is an independent risk factor for IAC burden, and that high IAC burden is an independent risk factor for ICH. Methods: A retrospective cohort of spontaneous ICH and non-ICH patients with non-contrast head CT imaging was identified. For each patient, eGFR (estimated glomerular filtration rate) along with age, sex, race, ethnicity, hypertension (HTN), diabetes (DM), heart disease, and hyperlipidemia were abstracted. A convolutional neural network was developed to automate quantification of IAC burden within the anterior and posterior circulation, and all results were visually verified for accuracy by an expert neuroradiologist. The relationship between eGFR and IAC was assessed with Pearson correlation and one-way ANOVA. Univariate analysis of ICH risk factors was evaluated using t-test and Chi-square, while multivariate models were analyzed using logistic regression. Results: Among the 717 patients in this study, 98 were ICH patients. In all patients, mean IAC burden increased significantly with CKD stage (p &lt; 0.01). Univariate analysis for IAC risk factors yielded statistically significant associations for eGFR (p &lt; 0.01) as well as age (p &lt; 0.01), HTN (p = 0.01), and African-American race (p = 0.02). In multivariate analysis, eGFR remained a significant independent predictor of IAC (p &lt; 0.01) along with HTN (p &lt; 0.01), DM (p &lt; 0.01), and race (p &lt; 0.01). Furthermore, IAC burden was significantly higher in ICH patients (15.4 mL vs. 8.7 mL, p = 0.02). In multivariate analysis, IAC remained a significant independent predictor of ICH (p &lt; 0.01) along with HTN (p &lt; 0.01), DM (p = 0.03), sex (p &lt; 0.01), and race (p &lt; 0.01). Conclusion: This is the first demonstration that eGFR predicts strictly quantified IAC, which then predicts ICH. These findings offer novel insights into determinants of IAC and mechanisms underlying the CKD-ICH relationship.

Abstract WP173: Major ABO Incompatible Platelet Transfusion is Associated With Ischemic Lesions on Brain MRI of Patients With Intracerebral Hemorrhage

Background: We identified that major ABO incompatible platelet transfusions are associated with poor intracerebral hemorrhage (ICH) outcomes, yet the driver for this relationship is unknown and does not appear to be related to impaired hemostasis. Conversely, acute ICH patients are known to develop remote ischemic lesions on brain MRI. These ischemic lesions are associated with poor ICH outcomes, but risk factors for their formation are unknown. We explored whether major ABO incompatible platelet transfusions are associated with these ischemic lesions. Methods: Consecutive spontaneous ICH patients enrolled into a single-center, prospective cohort study between 2009 and 2016 were assessed. Patients receiving an acute, single platelet transfusion within 24 h of admission and a brain MRI during their ICH admission were included. Major ABO incompatible platelet transfusion was the exposure. The presence of ischemic lesions on brain MRI, defined as diffusion restriction &gt;10 mm away from the hematoma was the outcome. Regression models assessed relationships between major ABO-incompatible platelets and ischemic lesions, adjusting for ICH severity and time to MRI. Results: Of 40 ICH patients with an acute platelet transfusion and MRI, the mean age was 67.1 (SD 14.1), 37.5% were female, and 20% received a major ABO incompatible platelet unit. Patients receiving a major incompatible platelet unit were more likely to have ischemic lesions (62.5% vs 21.9%), and there continued to be an association of major ABO-incompatible platelets units with these lesions after adjusting for time to MRI (OR 5.45, 95%CI 1.01-29.30, p=0.04) and ICH score (OR 9.15, 95%CI 1.37-62.67, p=0.02). Sensitivity analyses adjusting for patient blood type did not alter this relationship (OR 17.08, 95%CI 1.34-217.94, p = 0.03). Conclusions: Major ABO incompatible platelet units were associated with remote ischemic DWI lesions. Further work is needed to address the generalizability of our data and to clarify relationships of platelet unit characteristics, cerebral ischemia, and clinical outcomes after ICH.

Abstract TP158: Baseline Viscoelastic Hemostatic Assays and Associations With Poor Long-Term Intracerebral Hemorrhage Outcomes

Introduction: Viscoelastic hemostatic assays can detect coagulopathy relevant for intracerebral hemorrhage (ICH) patients at risk for hematoma expansion. However, it is unclear whether these assays associate with long term ICH outcomes. We sought to assess whether baseline coagulopathy detectable via viscoelastic hemostatic assay associates with poor 6-month neurological outcomes after ICH. Methods: Spontaneous ICH patients enrolled in a single-center prospective observational study from 2013 to 2020 who received baseline viscoelastic hemostatic assay testing via Rotational Thromboelastometry (ROTEM) were included. Patients with prior anticoagulant use were excluded. ROTEM assessments of coagulation kinetics and clot strength were the primary exposure variables. Poor 6-month neurological outcome was defined as modified Rankin Scale (mRS) 4-6. Multivariable logistic regression analyses assessed the relationships of ROTEM parameters with 6-month outcomes after adjusting for ICH score, hemoglobin, and sex. Results: Of 44 patients included for analysis, the mean age was 64, 57% were female, 52% had deep ICH, and the median ICH volume was 23.3 mL. Poor 6-month outcome was seen in 61%. We identified that slower coagulation kinetics was associated with poor 6-month outcome as assessed in both extrinsic and intrinsic pathways (EXTEM CFT: adjusted OR 1.06, 95% CI: 1.02-1.12, p=0.02; INTEM CFT: adjusted OR 1.05, 95% CI: 1.01-1.10, p=0.05, respectively). Weaker clot strength was also associated with poor 6-month outcome (EXTEM MCF: adjusted OR 0.78, 95% CI: 0.59-0.93, p=0.03; INTEM MCF: adjusted OR 0.83, 95% CI: 0.68-0.97). We did not identify similar relationships using conventional coagulation assays (ie., PT/PTT/INR, platelet count). Conclusions: We identified that baseline impaired coagulation kinetics and weaker clot strength seen using ROTEM testing associate with poor 6-month ICH outcomes. Further work is needed to clarify the generalizability of these findings and the mechanisms driving these relationships to assess whether viscoelastic guided therapies can potentially be used to improve long-term ICH outcomes.

Abstract TP159: Baseline Viscoelastic Hemostatic Assays and Associations With DWI Ischemic Lesions in Intracerebral Hemorrhage Patients

Introduction: Remote ischemic lesions identified on MRI neuroimaging after intracerebral hemorrhage (ICH) may be related to microthrombosis. We sought to evaluate whether hypercoagulability identified on viscoelastic hemostatic assay relates to these ischemic lesions. Methods: Spontaneous ICH patients enrolled in a single-center prospective observational study from 2009 to 2019 receiving baseline viscoelastic hemostatic assay: Rotational Thromboelastometry (ROTEM) and MRI neuroimaging were included. The presence and count of ischemic lesions identified on DWI imaging &gt;10 mm from the ICH were the outcome variables. ROTEM assessments of clot strength were the primary exposure variable. Logistic and linear regression assessed the association of ROTEM clot strength with DWI lesion presence and count after adjusting for ICH severity, ICH location, and anticoagulant use. Relationships of ROTEM assessments of coagulation kinetics and lysis with DWI lesions were explored. Results: Of 19 patients assessed, the mean age was 68, 37% were female, and DWI lesions were identified in 42%. Associations of greater ROTEM clot strength (FIBTEM MCF) with DWI lesions were imprecise (adjusted OR 1.16, 95%CI: 0.98-1.37, p=0.08). However, we identified that greater FIBTEM MCF significantly associated with increased DWI lesion count (adjusted β 0.16, 95%CI: 0.02-0.30, p=0.02). Exploratory analyses revealed that slower intrinsic pathway coagulation kinetics (INTEM CT) associated with increased DWI lesion count (adjusted β 0.06, 95% CI: 0.01-0.10, p=0.01). Conclusions: Baseline hypercoagulable ROTEM tracings may associate with DWI ischemic lesions after ICH. Further work is needed to clarify the generalizability of these findings and if specific coagulopathy mechanisms drive DWI lesion formation to assess whether there are relevant therapeutic targets to prevent secondary brain injury after ICH.

An Online Dynamic Radiomics–Clinical Nomogram to Predict Recurrence in Patients with Spontaneous Intracerebral Hemorrhage

ObjectiveRadiomics can reflect the heterogeneity within the focus. We aim to explore whether radiomics can predict recurrent intracerebral hemorrhage (RICH) and develop an online dynamic nomogram to predict it. MethodsThis retrospective study collected the clinical and radiomics features of spontaneous intracerebral hemorrhage (ICH) patients seen in our hospital from October 2013 to October 2016. We used the minimum redundancy maximum relevancy and the least absolute shrinkage and selection operator methods to screen radiomics features and calculate Rad-score. We use the univariate and multivariate analyses to screen clinical predictors. Optimal clinical features and Rad-score were used to construct different logistics regression models called the clinical model, radiomics model, and combined-LR model. The Delong testing was performed to compare performance between different models. The model with the best predictive performance was used to construct an online dynamic nomogram. ResultsOverall, 304 ICH patients were enrolled in this study. 14 radiomics features was selected to calculate the Rad-score. The patients with RICH had a significantly higher Rad-score than without (0.5 VS. -0.8, p < 0.001). The predictive performance of the combined-LR model with Rad-score was better than that of the clinical model for both the training (AUC, 0.81 vs. 0.71, p = 0.02) and testing (AUC, 0.65 vs. 0.58, p = 0.04) cohorts in statistically. ConclusionsRadiomics features were determined related to RICH. Adding Rad-score into conventional clinical models significantly improves the prediction efficiency. We developed a online dynamic nomogram to accurately and conveniently evaluate RICH.

Association of inflammatory cytokines expression in cerebrospinal fluid with the severity and prognosis of spontaneous intracerebral hemorrhage

ObjectiveTo investigate the potential diagnostic and prognostic implications of inflammatory cytokine levels in the cerebrospinal fluid (CSF) of patients with spontaneous intracerebral hemorrhage (SICH) upon their initial hospital admission.MethodsOur cohort included 100 patients diagnosed with acute SICH, presenting to the Department of Neurosurgery. Additionally, we recruited 50 individuals without central nervous system (CNS) pathology, treated concurrently at our facility, as controls. CSF samples, collected upon hospital entry, were quantitatively assessed for 10 inflammatory cytokines using the Mesoscale Discovery Platform (MSD, Rockville, MD, USA) electrochemiluminescence technology, followed by validation through enzyme-linked immunosorbent assay (ELISA).ResultsWe observed a marked elevation of IL-6, IL-8, IL-10, and TNF-α in the CSF of the SICH subgroup compared to controls. Higher Glasgow Coma Scale (GCS) scores in SICH patients corresponded with lower CSF concentrations of IL-6, IL-8, IL-10, and TNF-α, indicating an inverse relationship. Notably, CSF inflammatory cytokine levels were consistently higher in SICH patients with hydrocephalus than in those without. Increases in IL-6, IL-8, IL-10, and TNF-α in the CSF were notably more pronounced in the poor prognosis group (Glasgow Outcome Scale, GOS 1–3) compared to those with a favorable prognosis (GOS 4–5). The AUC values for these cytokines in predicting SICH prognosis were 0.750, 0.728, 0.717, and 0.743, respectively.ConclusionsInitial CSF levels of IL-6, IL-8, IL-10, and TNF-α upon admission provide significant insights into the severity of neural damage and are robust indicators for prognosis in SICH patients.

ABO-Incompatible Platelet Transfusion Is Associated with Ischemic Lesions on Brain MRI in Patients with Intracerebral Hemorrhage

Background: We have identified that major ABO-incompatible platelet transfusions are associated with poor intracerebral hemorrhage (ICH) outcomes. The underlying drivers for the relationship of these incompatible platelet units on outcome are unknown, yet do not appear to be related to impaired hemostasis. Conversely, ICH patients are known to encounter remote, “silent” ischemic lesions, thought to be from microthrombosis, during their hospitalization. Though these ischemic lesions are well known to associate with poor ICH outcomes, risk factors for its formation are unknown. We explored whether major ABO-incompatible platelet transfusions are associated with acute ischemic lesions on brain MRI during an ICH hospitalization. Methods: Consecutive spontaneous ICH patients enrolled into a single-center, prospective cohort study between 2009 and 2018 were assessed. Patients who received a single platelet transfusion within 24 hours of ICH admission and had a brain MRI during the hospitalization were included in the analysis. Major ABO incompatible platelet transfusion (vs minor mismatch/identical) was defined as the exposure. Presence of remote ischemic lesions, defined as diffusion restriction &amp;gt;10 mm away from the hematoma detected on brain MRI, was the outcome. Regression models were used to assess relationships between major ABO-incompatible platelet unit exposure and acute ischemic brain lesions, adjusting for time from ICH onset to MRI or ICH severity. Results: We identified 40 ICH patients receiving an acute platelet transfusion and having a brain MRI performed during the ICH hospitalization. The mean age was 67.1 (SD 14.1), 37.5% were female, and 20% received a major ABO incompatible platelet unit. Patients receiving a major incompatible platelet unit were more likely to encounter ischemic lesions (62.5% vs 21.9%). We also identified an association of major ABO-incompatible platelets units with acute ischemic brain lesions in our regression models after adjusting for time from ICH symptom onset to MRI (OR 5.45, 95%CI 1.01-29.30, p=0.048) and ICH severity (OR 9.15, 95%CI 1.37-62.67, p=0.024). Additional sensitivity analysis adjusting for patient blood type did not alter this relationship (OR 17.1, 95%CI 1.34-217.9, p = 0.029). Conclusions: Among ICH patients receiving acute platelet transfusions and MRI neuroimaging, major ABO incompatible units were associated with remote ischemic lesions on brain MRI. Further work is needed to address the generalizability of our data and to clarify relationships of platelet unit characteristics, cerebral microthrombosis, and clinical outcomes after ICH.

Platelet transfusion for spontaneous intracerebral hemorrhage with prior antiplatelet: A systematic review and meta-analysis.

Recent studies have highlighted the unfavorable prognosis of patients with spontaneous intracerebral hemorrhage (ICH) who have received prior antiplatelet therapy (PAP). Platelet infusion therapy (PIT) is commonly administered to such patients at many medical institutions, but its efficacy remains a subject of debate. To address this uncertainty, we conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library databases for eligible studies published before June 30, 2023. Our primary outcomes of interest were favorable functional outcome and mortality, while secondary outcomes included the incidence of hematoma expansion and adverse events associated with PIT. Meta-analysis was performed using Review Manager 5.3. Our analysis included 1 randomized controlled trial (RCT) and 6 retrospective studies, involving a total of 577 patients. Pooled analysis revealed that PIT did not contribute to a better favorable functional outcome at the 3-month follow-up (OR = 0.49, 95% CI 0.27-0.89) among ICH patients with PAP. Furthermore, PIT did not significantly reduce the risk of mortality (OR = 0.79, 95% CI 0.40-1.55) or hematoma expansion (OR = 1.15, 95% CI 0.65-2.01). Notably, no significant differences in serious adverse events were observed between patients who underwent PIT and those who did not. Based on the available evidence, there is no indication that PIT can enhance the prognosis of spontaneous ICH patients with prior antiplatelet therapy, although this treatment approach appears to be safe. Therefore, routine recommendation of PIT for ICH patients with prior antiplatelet therapy is not warranted.

Assessing characteristics, treatment approaches, and outcomes of spontaneous intracerebral hemorrhage patients in intensive care: a retrospective study

Assessing characteristics, treatment approaches, and outcomes of spontaneous intracerebral hemorrhage patients in intensive care: a retrospective study

Absolute and relative iodine concentrations in the spot sign and haematoma for prediction of haematoma expansion in spontaneous intracerebral haemorrhage

To explore the predictive value of absolute and relative iodine concentrations in the spot sign (SS) and haematoma on gemstone spectral imaging (GSI) for haematoma expansion (HE). Patients with spontaneous intracerebral haemorrhage (ICH) who underwent computed tomography (CT) angiography using GSI were divided into an SS-positive group and an SS-negative group. In the SS-positive group, absolute and relative iodine concentrations in the SS (aICIS and rICIS, respectively) were measured. In the SS-negative group, absolute and relative iodine concentrations in haematoma (aICIH and rICIH, respectively) were measured. The area under the receiver operating characteristic curve (AUC-ROC) was used to investigate the HE predictive performance of aICIS, rICIS, and their combination in the SS-positive group, as well as the HE predictive performance of aICIH, rICIH, and their combination in the SS-negative group. The risk variables for HE in the two groups were investigated separately using logistic regression. A total of 123 spontaneous ICH patients were enrolled. In the SS-positive group, the AUC of aICIS, rICIS, and their combination for predicting HE were 0.853, 0.893, and 0.922, respectively. rICIS was demonstrated to be a standalone predictor of HE via logistic regression. In the SS-negative group, aICIH, rICIH, and their combination had AUC-ROC values of 0.552, 0.783, and 0.851, respectively, to predict HE. According to multivariate analysis, rICIH was a reliable predictor of HE. Absolute and relative iodine concentrations in the SS and haematoma can predict HE.

Intracerebral Hemorrhage Score as a Prognosis Prediction of Spontaneous Intracerebral Hemorrhage at RSI Surabaya Jemursari

Highlight: Spontaneous intracerebral hemorrhage, or hemorrhagic stroke, is one of the leading causes of mortality and disability in Indonesia. The intracerebral hemorrhage (ICH) score is a widely used predictive tool for the prognosis of death 30 days after spontaneous intracerebral hemorrhage, but the intracerebral hemorrhage-grading scale (ICH-GS) score has a more specific interval to assess prognosis prediction after intracerebral. The higher the total score, the more likely it is to have a poor outcome. The results of this study indicate that patients with a high total score did not always die. ABSTRACT Introduction: Spontaneous intracerebral hemorrhage, or hemorrhagic stroke, is one of the leading causes of mortality and disability in Indonesia. Objective: The intracerebral hemorrhage (ICH) score is a widely used predictive tool for the prognosis of death 30 days after spontaneous intracerebral hemorrhage, but the intracerebral hemorrhage-grading scale (ICH-GS) score has a more specific interval to assess prognosis prediction after intracerebral hemorrhage. Methods: The type of research used was observational-retrospective research. The population included all patients with spontaneous intracerebral hemorrhage hospitalized at RSI Jemursari Surabaya in 2017–2019. Results: The results revealed that there were 110 spontaneous intracerebral hemorrhage patients with complete data in medical e-records during 2017–2019; 65.5% (72 patients) were male and 34.5% (38 patients) were female. The data showed that 20% (22 patients) had an ICH-GS score of 8 and 0.9% (1 patient) had an ICH-GS score of 12. Conclusion: The higher the total score, the more likely it is to have a poor outcome. The results of this study indicate that patients with a high total score did not always die.

The trend of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in spontaneous intracerebral hemorrhage and the predictive value of short-term postoperative prognosis in patients.

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) play an important role in the inflammatory response in various diseases, but the role in the course of spontaneous intracerebral hemorrhage (ICH) is unclear. This study retrospectively collected baseline characteristics and laboratory findings, including NLR and PLR at different time points, from spontaneous ICH patients undergoing surgery between January 2016 and June 2021. Patients were scored using the modified Rankin Scale (mRS) to evaluate their functional status at 30 days post-operation. Patients with mRS score ≥3 were defined as poor functional status, and mRS score <3 was defined as good functional status. The NLR and PLR were calculated at admission, 48 h after surgery and 3-7 days after surgery, respectively, and their trends were observed by connecting the NLR and PLR at different time points. Multivariate logistic regression analysis was used to identify independent risk factors affecting the prognosis of ICH patients at 30 days after surgery. A total of 101 patients were included in this study, and 59 patients had a poor outcome at 30 days after surgery. NLR and PLR gradually increased and then decreased, peaking at 48 h after surgery. Univariate analysis demonstrated that admission Glasgow Coma Scale (GCS) score, interval from onset to admission, hematoma location, NLR within 48 h after surgery and PLR within 48 h after surgery were associated with poor 30-day prognosis. In multivariate logistic regression analysis, NLR within 48 h after surgery (OR, 1.147; 95% CI, 1.005, 1.308; P, 0.042) was an independent risk factor for 30-day after surgery prognosis in spontaneous ICH patients. In the course of spontaneous intracerebral hemorrhage, NLR and PLR initially increased and subsequently decreased, reaching their peak values at 48 h after surgery. High NLR within 48 h after surgery was an independent risk factor for poor prognosis 30 days after surgery in spontaneous ICH patients.