Spontaneous Intracerebral Hemorrhage Patients Research Articles

Characteristics, predictors and outcomes of early postoperative cerebral infarction on computed tomography in spontaneous intracerebral hemorrhage

Early postoperative cerebral infarction (ePCI) is a serious complication of spontaneous intracerebral hemorrhage (SICH). Yet, no study has specifically focused on ePCI among SICH patients. Our study aims to investigate the characteristics, predictors, and outcomes of ePCI observed on computed tomography (CT) within 72 h after surgery in patients with supratentorial SICH. Data from a single-center SICH study conducted from May 2015 to September 2022 were retrospectively analyzed. We described the characteristics of ePCI. Predictors were identified through logistic regression analysis, and the impact of ePCI on six-month mortality was examined using a Cox regression model. Subgroup analyses and the “E-value” approach assessed the robustness of the association between ePCI and mortality. A retrospective analysis of 637 out of 3938 SICH patients found that 71 cases (11.1%) developed ePCI. The majority of ePCI cases occurred on the bleeding side (40/71, 56.3%) and affected the middle cerebral artery (MCA) territory (45/71, 63.4%). Multivariable analysis showed that the Glasgow Coma Scale (GCS) score (odds ratio (OR), 0.62; 95% CI, 0.48–0.8; p < 0.001), bleeding volume (per 100 ml) (OR, 1.17; 95% CI, 1.03–1.32; p = 0.016), hematoma volume (per 10 ml) (OR, 1.14; 95%CI, 1.02–1.28; p = 0.023) and bilateral brain hernia (OR, 6.48; 95%CI, 1.71–24.48; p = 0.006) independently predicted ePCI occurrence. ePCI was significantly associated with increased mortality (adjusted hazard ratio (HR), 3.6; 95% CI, 2.2—5.88; p < 0.001). Subgroup analysis and E-value analysis (3.82—6.66) confirmed the stability of the association. ePCI is a common complication of SICH and can be predicted by low GCS score, significant bleeding, large hematoma volume, and brain hernia. Given its significant increase in mortality, ePCI should be explored in future studies.

Clinical Characteristics and Outcome of Spontaneous Intracerebral Hemorrhage

Background: Stroke is the second leading cause of death and disability globally. Intracerebral hemorrhage represents a prominent subtype comprising 10-20% of all strokes and posing substantial challenges, particularly in low-income countries. This study aims to unravel the clinical profile and outcomes of spontaneous ICH patients at our institute. Materials and Methods: This is a prospective observational study conducted at the department of Neurosurgery Nobel Medical College Teaching Hospital, Biratnagar, Nepal over a period of one and half years. Results: In the Present study, a total of 285 populations were studied, where there was male preponderance with the mean age of 57.9 years. Commonest clinical manifestation was sudden onset headache (75.1%) followed by decreased level of consciousness. Hypertension was the commonest cause of ICH. Basal ganglia were the primary location of bleed. The statistical analysis revealed a significant difference in the mean clot volume between survivors and non-survivors. There was a strong association between ventricular extension of hematoma and outcome. Surgical hematoma evacuation was performed in 30.9% of cases. Favorable outcomes, defined by a modified Rankin Scale score of 0-3, were achieved in 58.9% of participants. Conclusion: Age, sudden onset headache, and hypertension predict mortality in primary intracerebral hemorrhage (ICH), particularly with advanced age linked to poorer outcomes. A Glasgow Coma Score less than eight increases mortality risk, while clot volume and intraventricular extension play crucial roles in ICH outcome.

Systemic immune-inflammation index and serum glucose-potassium ratio predict poor prognosis in patients with spontaneous cerebral hemorrhage: An observational study.

Recent studies have shown systemic inflammatory response, serum glucose, and serum potassium are associated with poor prognosis in spontaneous intracerebral hemorrhage (SICH). This retrospective study aimed to investigate the association of systemic immune-inflammatory index (SII) and serum glucose-potassium ratio (GPR) with the severity of disease and the poor prognosis of patients with SICH at 3 months after hospital discharge. We reviewed the clinical data of 105 patients with SICH, assessed the extent of their disease using Glasgow Coma Scale score, National Institutes of Health Stroke Scale (NIHSS) score, and hematoma volume, and categorized them into a good prognosis group (0-3 scores) and a poor prognosis group (4-6 scores) based on their mRS scores at 3 months after hospital discharge. Demographic characteristics, clinical, laboratory, and imaging data at admission were compared between the 2 groups, bivariate correlations were analyzed using Spearman's correlation coefficients, multivariate logistic regression analysis was used to determine the independent risk factors for poor prognosis of patients with SICH, and finally, SII, GPR, and platelet/lymphocyte ratio (PLR) were examined using the subject's work characteristics (ROC) curve, lymphocyte/monocyte ratio (LMR), and neutrophil/lymphocyte ratio (NLR) for their predictive efficacy for poor prognosis. Patients in the poor prognosis group had significantly higher SII and serum GPR than those in the good prognosis group, and Spearman analysis showed that SII and serum GPR were significantly correlated with the admission Glasgow Coma Scale score as well as the NIHSS score and that SII and GPR increased with the increase in mRS score. Multivariate logistic regression analysis showed that admission NIHSS score, hematoma volume SII, GPR, NLR, and PLR were independently associated with poor patient prognosis. Analysis of the subjects' work characteristic curves showed that the areas under the SII, GPR, NLR, PLR, LMR, and coSII-GPR curves were 0.838, 0.837, 0.825, 0.718, 0.616, and 0.883. SII and GRP were significantly associated with disease severity and short-term prognosis in SICH patients 3 months after discharge, and SII and GPR had better predictive value compared with NLR, PLR, and LMR. In addition, coSII-GPR, a joint indicator based on SII and GPR, can improve the predictive accuracy of poor prognosis 3 months after discharge in patients with SICH.

Recent Updates of Stem Cell Therapy in Spontaneous Intracerebral Haemorrhage Patients: A Review Article

Recent Updates of Stem Cell Therapy in Spontaneous Intracerebral Haemorrhage Patients: A Review Article

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.

Development of a Predictive Nomogram Model for Early Deep Vein Thrombosis in Postoperative Spontaneous Intracerebral Hemorrhage Patients.

This study explores risk determinants for participants' lower extremities deep vein thrombosis (DVT) in the perioperative phase after spontaneous intracerebral hemorrhage (SICH), thereby informing more effective clinical prevention and treatment strategies. During the period spanning October 2021 to March 2024, clinical data from 96 participants who received surgical treatment for spontaneous cerebral hemorrhage was analyzed in a retrospective study. Participants were classified into DVT and negative-DVT groups within the first week post-surgery. We used univariate logistic regression and multivariate logistic regression analyses to assess the impact of various clinical variables on DVT. A nomogram model was constructed to forecast the occurrence of early DVT following SICH surgery. The model's performance was assessed and validated using receiver operating characteristic (ROC) curves and bootstrap resampling. Among the 96 participants, 46 developed DVT. Significant differences were noted in age, D-dimer levels, fibrinogen degradation products, Caprini scores, and total surgical bleeding volume between the groups. Multivariate analysis revealed that Caprini score (the values of OR, 95% CI, and P are 1.962, 1.124-3.424, and 0.018, respectively) and total surgical bleeding volume (the values of OR, 95% CI, and P are 1.010, 1.002-1.018, and 0.017, respectively) were risk variables contributing to DVT occurrence. The area under the receiver operating characteristic curve was 0.918 (95% CI, 0.821-0.988). The calibration curve showed good prediction accuracy. The Caprini score and total surgical bleeding volume are meaningful self-reliant risk variables contributing to DVT occurrence in postoperative participants with SICH. We have created a straightforward and efficient model to predict early DVT post-SICH surgery. This model serves as a valuable clinical tool for evaluating individual risk and enhancing decision-making processes.

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.