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Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage.

TitleRate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage.
Publication TypeJournal Article
Year of Publication2016
AuthorsMurthy SB, Urday S, Beslow LA, Dawson J, Lees K, W Kimberly T, Iadecola C, Kamel H, Hanley DF, Sheth KN, Ziai WC
Corporate AuthorsVISTA ICH Collaborators
JournalJ Neurol Neurosurg Psychiatry
Volume87
Issue11
Pagination1169-1173
Date Published2016 Nov
ISSN1468-330X
KeywordsAged, Brain Edema, Cerebral Hemorrhage, Disability Evaluation, Disease Progression, Female, Hematoma, Hospital Mortality, Humans, Male, Middle Aged, Multivariate Analysis, Outcome Assessment, Health Care, Predictive Value of Tests, ROC Curve, Tomography, X-Ray Computed
Abstract

BACKGROUND: Perihaematomal edema (PHE) expansion rate may be a predictor of outcome after intracerebral haemorrhage (ICH). We determined whether PHE expansion rate in the first 72 hours after ICH predicts outcome, and how it compares against other PHE measures.

METHODS: We included patients from the Virtual International Stroke Trials Archive. We calculated PHE expansion rate using the equation: (PHE at 72 hours PHE at baseline)/(time to 72-hour CT scan time to baseline CT scan). Outcomes of interest were mortality and poor 90-day outcome (modified Rankin Scale score of ≥3). Logistic regression was used to assess relationships with outcome.

RESULTS: A total of 596 patients with ICH were included. At baseline, median haematoma volume was 15.0 mL (IQR 7.9-29.2) with median PHE volume of 8.7 mL (IQR 4.5-15.5). Median PHE expansion rate was 0.31 mL/hour (IQR 0.12-0.55). The odds of mortality were greater with increasing PHE expansion rate (OR 2.63, CI 1.10 to 6.25), while the odds of poor outcome also increased with greater PHE growth (OR 1.67, CI 1.28 to 2.39). Female sex had an inverse relationship with PHE growth, but baseline haematoma volume had a direct correlation. Among other PHE measures, only interval increase in PHE correlated with poor outcome. There was no significant difference between the 2 measures of PHE volume expansion.

CONCLUSIONS: Rate of PHE growth over 72 hours was an independent predictor of mortality and poor functional outcomes following ICH. Baseline haematoma volume and gender appear to influence PHE growth.

DOI10.1136/jnnp-2016-313653
Alternate JournalJ. Neurol. Neurosurg. Psychiatry
PubMed ID27466360
PubMed Central IDPMC5299159
Grant ListU01 NS062851 / NS / NINDS NIH HHS / United States
R01 NS037853 / NS / NINDS NIH HHS / United States
UL1 TR001863 / TR / NCATS NIH HHS / United States
R01 NS073666 / NS / NINDS NIH HHS / United States
R01 NS034179 / NS / NINDS NIH HHS / United States
U01 NS080824 / NS / NINDS NIH HHS / United States
K23 NS076597 / NS / NINDS NIH HHS / United States
K12 NS049453 / NS / NINDS NIH HHS / United States
R37 NS089323 / NS / NINDS NIH HHS / United States
K23 NS082367 / NS / NINDS NIH HHS / United States

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