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

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Abstract

Background

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.

Methods

Subjects (n = 115) were retrospectively identified from a prospective ICH cohort enrolled from 2000 to 2013. Inclusion criteria were age ≥ 18 years, 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 0.04 mL/h.

Results

PHE expansion rate from baseline to 24 h (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 72 h (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]).

Conclusions

PHE72 was associated with poor functional outcomes after deep ICH, whereas PHE24 was associated with mortality for deep and lobar ICH.

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Funding

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the NIH (Grants T35HL007649 and HL082517; Mr. Grunwald and Dr. Simard). This work was also supported by the NIH (Grants R01AG26484 and 5R01NS059727; Drs. Greenberg and Rosand and Mses. Ayres and Vashkevich), National Institute of Neurological Disorders and Stroke (Grants NS060801 and NS061808, Dr. Simard), and American Heart Association (Grant 16SDG27250236, Dr. Shi).

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Authors and Affiliations

  1. Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA

    Zachary Grunwald, Lauren A. Beslow, Sebastian Urday, Audrey Leasure & Kevin N. Sheth

  2. Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Anastasia Vashkevich, Alison Ayres, Steven M. Greenberg, Joshua N. Goldstein, Thomas W. K. Battey, Jonathan Rosand & W. Taylor Kimberly

  3. Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Fu-Dong Shi

  4. Departments of Neurosurgery, Pediatrics, and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA

    Kristopher T. Kahle

  5. Departments of Neurosurgery, Pathology and Physiology, University of Maryland School of Medicine, Baltimore, MA, USA

    J. Marc Simard

Authors
  1. Zachary Grunwald
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  2. Lauren A. Beslow
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  3. Sebastian Urday
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  4. Anastasia Vashkevich
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  6. Steven M. Greenberg
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  7. Joshua N. Goldstein
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  8. Audrey Leasure
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  9. Fu-Dong Shi
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  12. J. Marc Simard
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  13. Jonathan Rosand
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  14. W. Taylor Kimberly
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  15. Kevin N. Sheth
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Corresponding author

Correspondence to Zachary Grunwald.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Grunwald, Z., Beslow, L.A., Urday, S. et al. Perihematomal Edema Expansion Rates and Patient Outcomes in Deep and Lobar Intracerebral Hemorrhage. Neurocrit Care 26, 205–212 (2017). https://doi.org/10.1007/s12028-016-0321-3

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