1. Predictors of severe intracerebral hemorrhage expansion.
- Author
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Morotti A, Li Q, Nawabi J, Busto G, Mazzacane F, Cavallini A, Shoamanesh A, Morassi M, Schlunk F, Piccolo L, Urbinati G, Pezzini D, Paciaroni M, Fainardi E, Casetta I, Padovani A, and Zini A
- Subjects
- Humans, Female, Aged, Retrospective Studies, Middle Aged, Male, Tomography, X-Ray Computed, Aged, 80 and over, Cerebral Angiography, Cerebral Hemorrhage diagnostic imaging, Cerebral Hemorrhage diagnosis, Cerebral Hemorrhage pathology, Computed Tomography Angiography methods, Hematoma diagnostic imaging
- Abstract
Background: Severe hematoma expansion (sHE) has the strongest impact on intracerebral hemorrhage (ICH) outcome. We investigated the predictors of sHE., Methods: Retrospective analysis of ICH patients admitted at nine sites in Italy, Germany, China, and Canada. The following imaging features were analyzed: non-contrast CT (NCCT) hypodensities, heterogeneous density, blend sign, irregular shape, and CT angiography (CTA) spot sign. The outcome of interest was sHE, defined as volume increase >66% and/or >12.5 from baseline to follow-up NCCT. Predictors of sHE were explored with logistic regression., Results: A total of 1472 patients were included (median age 73, 56.6% males) of whom 223 (15.2%) had sHE. Age (odds ratio (OR) per year, 95% confidence interval (CI), 1.02 (1.01-1.04)), Anticoagulant treatment (OR 3.00, 95% CI 2.09-4.31), Glasgow Coma Scale (OR 0.93, 95% CI 0.89-0.98), time from onset/last known well to imaging, (OR per h 0.96, 95% CI 0.93-0.99), and baseline ICH volume, (OR per mL 1.02, 95% CI 1.02-1.03) were independently associated with sHE. Ultra-early hematoma growth (baseline volume/baseline imaging time) was also a predictor of sHE (OR per mL/h 1.01, 95% CI 1.00-1.02). All NCCT and CTA imaging markers were also predictors of sHE. Amongst imaging features NCCT hypodensities had the highest sensitivity (0.79) whereas the CTA spot sign had the highest positive predictive value (0.51)., Conclusions: sHE is common in the natural history of ICH and can be predicted with few clinical and imaging variables. These findings might inform clinical practice and future trials targeting active bleeding in ICH., Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Morotti has received expert meeting and advisory board honoraria from EMG-REG International and AstraZeneca. Dr. Shoamanesh has received speaker and consultation fees from AstraZeneca, Takeda Pharmaceuticals; and research funding from Alexion and Octapharma Canada. Dr. Paciaroni has received honoraria as a member of the speaker bureau of Sanofi-Aventis, BMS, Daiichi Sankyo, Pfizer, and iRhythm. Dr. Zini has received speaker and consultation fees from Alexion, CLS-Behring, Boehringer-Ingelheim. All the other authors report no disclosures.
- Published
- 2024
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