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Hematoma Expansion Differences in Lobar and Deep Primary Intracerebral Hemorrhage

  • David RohEmail author
  • Chung-Huan Sun
  • Santosh Murthy
  • Mitchell S. V. Elkind
  • Samuel S. Bruce
  • Kara Melmed
  • Natasha Ironside
  • Amelia Boehme
  • Kevin Doyle
  • Daniel Woo
  • Hooman Kamel
  • Soojin Park
  • Sachin Agarwal
  • E. Sander Connolly
  • Jan Claassen
Original Article

Abstract

Background

Hematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with worse outcome. Lobar ICHs are known to have better outcomes compared to deep ICH; however, it is unclear whether there are HE differences between these locations. We sought to investigate the hypothesis that lobar ICH has less HE compared to deep ICH.

Methods

Primary ICH patients admitted between 2009 and 2016 were included in a prospective single-center ICH cohort study. Patients with preceding anticoagulant use, coagulopathy on admission labs, or presenting after 24 h from symptom onset were excluded. Lobar and deep ICH patients with baseline and follow-up computed tomography (CT) (within 24 h of admission CT) were evaluated. HE was defined primarily as relative growth > 33% given expected baseline hematoma volume differences between locations. Other commonly utilized definitions of HE: > 6 mL, and > 33% or > 6 mL, were additionally assessed. Multivariable logistic regression was used to assess the association of ICH location with HE while adjusting for previously identified covariates of HE.

Results

There were 59 lobar and 143 deep ICH patients analyzed. Lobar ICH patients had significantly larger baseline hematoma volumes, lower admission systolic blood pressure, and longer times to admission CT compared to deep ICH. Multivariable logistic regression revealed an association of lobar ICH with lower odds of HE (> 33%) [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.11–0.93; p = 0.04] compared to deep ICH after adjusting for baseline ICH volume, blood pressure, and time to CT. Secondary analysis did not identify an association of lobar ICH with HE defined as > 6 mL (adjusted OR 1.44; 95% CI 0.59–3.50; p = 0.41) or > 33% or > 6 mL (adjusted OR 0.71; 95% CI 0.29–1.70; p = 0.44).

Conclusion

We identified less HE in lobar compared to deep ICH. The use of absolute growth thresholds in defining HE may be limited when assessing groups with largely different baseline hematoma sizes. Further study is required to replicate our findings and investigate mechanisms for HE differences between lobar and deep ICH locations.

Keywords

Intracerebral hemorrhage Hematoma expansion Lobar Deep 

Notes

Author Contributions

DR contributed to project development, data collection, data analysis, and manuscript writing. C-HS contributed to data collection and manuscript writing/editing. SM contributed to project development and manuscript writing/editing. MSVE contributed to project development and manuscript writing/editing. SSB contributed to data analysis. KM contributed to data collection and data analysis. NI contributed to data collection and data management. AB contributed to data analysis. KD contributed to data analysis, data management, and manuscript writing/editing. DW contributed to project development and manuscript editing. HK contributed to project development. SP contributed to data collection, data management, and manuscript editing. SA contributed to data collection, data management, and manuscript editing. ESC contributed to data collection, data management, project development, and manuscript editing. JC contributed to data collection, data management, project development, and manuscript editing.

Source of Support

Dr. Roh is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1TR001873. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Columbia University Institutional Review Board.

Supplementary material

12028_2018_668_MOESM1_ESM.pdf (6 kb)
Supplementary material 1 (PDF 6 kb)
12028_2018_668_MOESM2_ESM.pdf (181 kb)
Supplementary material 2 (PDF 181 kb)
12028_2018_668_MOESM3_ESM.pdf (41 kb)
Supplementary material 3 (PDF 41 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  • David Roh
    • 1
    Email author
  • Chung-Huan Sun
    • 1
  • Santosh Murthy
    • 2
  • Mitchell S. V. Elkind
    • 1
  • Samuel S. Bruce
    • 1
  • Kara Melmed
    • 1
  • Natasha Ironside
    • 1
  • Amelia Boehme
    • 1
  • Kevin Doyle
    • 1
  • Daniel Woo
    • 3
  • Hooman Kamel
    • 2
  • Soojin Park
    • 1
  • Sachin Agarwal
    • 1
  • E. Sander Connolly
    • 1
  • Jan Claassen
    • 1
  1. 1.Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  2. 2.Weill Cornell Medical CenterNew YorkUSA
  3. 3.University of Cincinnati College of MedicineCincinnatiUSA

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