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Expansion-Prone Hematoma: Defining a Population at High Risk of Hematoma Growth and Poor Outcome

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Abstract

Background

Noncontrast computed tomography (CT) markers are increasingly used for predicting hematoma expansion. The aim of our study was to investigate the predictive value of expansion-prone hematoma in predicting hematoma expansion and outcome in patients with intracerebral hemorrhage (ICH).

Methods

Between July 2011 and January 2017, ICH patients who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. Expansion-prone hematoma was defined as the presence of one or more of the following imaging markers: blend sign, black hole sign, or island sign. The diagnostic performance of blend sign, black hole sign, island sign, and expansion-prone hematoma in predicting hematoma expansion was assessed. Predictors of hematoma growth and poor outcome were analyzed using multivariable logistical regression analysis.

Results

A total of 282 patients were included in our final analysis. Of 88 patients with early hematoma growth, 69 (78.4%) had expansion-prone hematoma. Expansion-prone hematoma had a higher sensitivity and accuracy for predicting hematoma expansion and poor outcome when compared with any single imaging marker. After adjustment for potential confounders, expansion-prone hematoma independently predicted hematoma expansion (OR 28.33; 95% CI 12.95–61.98) and poor outcome (OR 5.67; 95% CI 2.82–11.40) in multivariable logistic model.

Conclusion

Expansion-prone hematoma seems to be a better predictor than any single noncontrast CT marker for predicting hematoma expansion and poor outcome. Considering the high risk of hematoma expansion in these patients, expansion-prone hematoma may be a potential therapeutic target for anti-expansion treatment in future clinical studies.

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Funding

This study was supported by the National Natural Science Foundation of China (Grant No. 81200899, the National Health and Family Planning Commission of Chongqing (Grant No. 2017MSXM014), China Association for Science and Technology Young Talent Project (Grant No. 2017QNRC001) and National Key Research and Development Program of China (Nos. 2018YFC1312200, 2018YFC1312203).

Author information

Author notes

  1. Qi Li, Yi-Qing Shen and Xiong-Fei Xie have contributed equally to this work.

Authors and Affiliations

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

    Qi Li, Du Cao, Wen-Song Yang, Rui Li, Lan Deng & Peng Xie

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

    Yi-Qing Shen, Xiong-Fei Xie, Miao Wei & Fa-Jin Lv

  3. Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China

    Meng-Zhou Xue

  4. Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China

    Guo-Feng Wu

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

    Zhou-Ping Tang

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  1. Qi Li
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Contributions

QL had full access to all of the data in the study. QL, Z-PT, PX contributed to study concept and design; QL, Y-QS, X-FX, DC, RL, LD, MW helped in acquisition, analysis, or interpretation of data; QL contributed to drafting of the manuscript; QL, Y-QS, X-FX, M-ZX, Z-PT, GW, PX helped in critical revision of the manuscript; W-SY, F-JL contributed to statistical analysis; QL helped in obtaining funding; QL, PX contributed to administrative, technical, or material support.

Corresponding authors

Correspondence to Qi Li, Guo-Feng Wu, Zhou-Ping Tang or Peng Xie.

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Conflict of interest

The authors declare that they have no competing interests. No other Disclosures were reported.

Ethical Approval

The Ethics Committee of the First Affiliated Hospital of Chongqing Medical University, China, approved the study.

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Li, Q., Shen, YQ., Xie, XF. et al. Expansion-Prone Hematoma: Defining a Population at High Risk of Hematoma Growth and Poor Outcome. Neurocrit Care 30, 601–608 (2019). https://doi.org/10.1007/s12028-018-0644-3

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