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Intraventricular Hemorrhage Growth: Definition, Prevalence and Association with Hematoma Expansion and Prognosis

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Abstract

Background/Objectives

The objective of this study is to propose a definition of intraventricular hemorrhage (IVH) growth and to investigate whether IVH growth is associated with ICH expansion and functional outcome.

Methods

We performed a prospective observational study of ICH patients between July 2011 and March 2017 in a tertiary hospital. Patients were included if they had a baseline CT scan within 6 h after onset of symptoms and a follow-up CT within 36 h. IVH growth was defined as either any newly occurring intraventricular bleeding on follow-up CT scan in patients without baseline IVH or an increase in IVH volume ≥ 1 mL on follow-up CT scan in patients with initial IVH. Poor outcome was defined as modified Rankin Scale score of 3–6 at 90 days. The association between IVH growth and functional outcome was assessed by using multivariable logistic regression analysis.

Results

IVH growth was observed in 59 (19.5%) of 303 patients. Patients with IVH growth had larger baseline hematoma volume, higher NIHSS score and lower GCS score than those without. Of 44 patients who had concurrent IVH growth and hematoma growth, 41 (93.2%) had poor functional outcome at 3-month follow-up. IVH growth (adjusted OR 4.15, 95% CI 1.31–13.20; P = 0.016) was an independent predictor of poor functional outcome (mRS 3–6) at 3 months in multivariable analysis.

Conclusion

IVH growth is not uncommon and independently predicts poor outcome in ICH patients. It may serve as a promising therapeutic target for intervention.

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Acknowledgements

Dr. Goldstein has received consulting and research contracts from CSL Behring and Boehringer Ingelheim. No other disclosures were reported.

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Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Qi Li, Rui Li, Wen-Song Yang, Lan Deng, Xin-Ni Lv & Peng Xie

  2. Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China

    Li-Bo Zhao

  3. Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Xiao-Min Yang & Xiao-Chuan Sun

  4. Emergency Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550025, China

    Guo-Feng Wu

  5. Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Zhou-Ping Tang

  6. Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Miao Wei, Yi-Neng Zheng & Fa-Jin Lv

  7. Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Joshua N. Goldstein

Authors
  1. Qi Li
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  2. Rui Li
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  15. Peng Xie
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Contributions

Dr. QL took part in study concept and design. Drs. QL, RL, L-BZ, X-MY, W-SY, LD, X-NL, MW, Y-NZ, F-JL involved in acquisition of data. W-SY participated in statistical analysis. All authors participated in analysis and interpretation of data. Dr. QL. involved in drafting of the manuscript. QL, RL, L-BZ, JG and PX took part in critical revision of the manuscript for important intellectual content. Dr. QL. obtained funding. Drs. QL, X-CS and PX participated in study supervision.

Corresponding authors

Correspondence to Qi Li, Li-Bo Zhao or Peng Xie.

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Sources of Funding

This study was supported by grants from the National Key R&D Program of China (Nos. 2018YFC1312200, 2018YFC1312203) and Chongqing High-end Young Investigator Project (No. 2019GDRC005).

Conflicts of interest

The authors declare no competing interests.

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Written informed consent was obtained from all participants or their legal representatives.

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Qi Li and Rui Li are co-first authors.

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Li, Q., Li, R., Zhao, LB. et al. Intraventricular Hemorrhage Growth: Definition, Prevalence and Association with Hematoma Expansion and Prognosis. Neurocrit Care 33, 732–739 (2020). https://doi.org/10.1007/s12028-020-00958-8

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  • DOI: https://doi.org/10.1007/s12028-020-00958-8

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