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Acute hematoma expansion after spontaneous intracerebral hemorrhage: risk factors and impact on long-term prognosis

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Abstract

Introduction

Hematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with short-term mortality, but its impact on long-term prognosis is still unclear. The aim of this study was to evaluate the impact of HE on long-term survival and functional status after spontaneous ICH.

Methods

Consecutive patients admitted with spontaneous ICH were prospectively enrolled and followed up for a minimum of 2 years. We compared short-term (< 30 days) and long-term survival and functional status between ICH patients with HE (HE+) and those without (HE-). Main outcomes were mortality and poor outcome, defined as modified Rankin Scale ≥ 3. Secondary outcomes included recurrent ICH, admission to institutionalized care, and ischemic events (stroke, myocardial infarction, and systemic embolism).

Results

Overall, 140 patients were included (mean age 74.9 years, male 59.3%) and followed up for a mean of 2.25 years. HE+ patients (25.7%) had larger hematoma volume at admission (23.8 ml vs 15.3 ml, p < 0.05), higher NIHSS score (14.6 vs 10.5, p < 0.05) and higher cumulative mortality (59.3% vs 39.2%, p < 0.05) compared to HE- patients. Survival analysis showed that HE+ confers higher mortality and worse functional status at all time points. HE did not associate with secondary outcomes.

Discussion

HE translates into higher mortality and functional dependence over long-term follow-up. Strategies limiting HE might benefit long-term functional status.

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Author information

Author notes

  1. Agnese Sembolini and Michele Romoli contributed equally to this work.

Authors and Affiliations

  1. Emergency Medicine, Ravenna Hospital – AUSL Romagna, Rimini, Italy

    Agnese Sembolini

  2. Neurology Unit, Rimini “Infermi” Hospital – AUSL Romagna, Rimini, Italy

    Michele Romoli

  3. Department of Medicine, University of Perugia, Perugia, Italy

    Umberto Pannacci

  4. Radiology and Diagnostics, Assisi Hospital – USL Umbria1, Assisi, Italy

    Giulio Gambaracci

  5. Neuroradiology, University of Perugia – Santa Maria della Misericordia Hospital, Perugia, Italy

    Piero Floridi

  6. Stroke Unit, University of Perugia – Santa Maria della Misericordia Hospital, Perugia, Italy

    Monica Acciarresi, Giancarlo Agnelli, Andrea Alberti, Michele Venti, Maurizio Paciaroni & Valeria Caso

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  1. Agnese Sembolini
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Correspondence to Michele Romoli.

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Perugia Stroke Registry had internal advisory board approval, and informed consent was obtained [23].

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Sembolini, A., Romoli, M., Pannacci, U. et al. Acute hematoma expansion after spontaneous intracerebral hemorrhage: risk factors and impact on long-term prognosis. Neurol Sci 41, 2503–2509 (2020). https://doi.org/10.1007/s10072-020-04356-y

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