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Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

Authors :
Al-Shahi Salman, Rustam
Frantzias, Joseph
Lee, Robert J.
Lyden, Patrick D.
Battey, Thomas W.K.
Ayres, Alison M.
Goldstein, Joshua N.
Mayer, Stephan A.
Steiner, Thorsten
Wang, Xia
Arima, Hisatomi
Hasegawa, Hitoshi
Oishi, Makoto
Godoy, Daniel A.
Masotti, Luca
Dowlatshahi, Dar
Rodriguez-Luna, David
Molina, Carlos A.
Jang, Dong-Kyu
Davalos, Antonio
Castillo, José
Yao, Xiaoying
Claassen, Jan
Volbers, Bastian
Kazui, Seiji
Okada, Yasushi
Fujimoto, Shigeru
Toyoda, Kazunori
Li, Qi
Khoury, Jane
Delgado, Pilar
Sabín, José Álvarez
Hernández-Guillamon, Mar
Prats-Sánchez, Luis
Cai, Chunyan
Kate, Mahesh P.
McCourt, Rebecca
Venkatasubramanian, Chitra
Diringer, Michael N.
Ikeda, Yukio
Worthmann, Hans
Ziai, Wendy C.
d'Esterre, Christopher D.
Aviv, Richard I.
Raab, Peter
Murai, Yasuo
Zazulia, Allyson R.
Butcher, Kenneth S.
Seyedsaadat, Seyed Mohammad
Grotta, James C.
Martí-Fàbregas, Joan
Montaner, Joan
Broderick, Joseph
Yamamoto, Haruko
Staykov, Dimitre
Connolly, E. Sander
Selim, Magdy
Leira, Rogelio
Moon, Byung Hoo
Demchuk, Andrew M.
Di Napoli, Mario
Fujii, Yukihiko
Anderson, Craig S.
Rosand, Jonathan
Hanley, Daniel F.
Davis, Stephen
Gregson, Barbara
Lees, Kennedy R.
VISTA-ICH Collaboration
Xie, Peng
Bakhshayesh, Babak
McDonald, Mark
Brott, Thomas
Pennati, Paolo
Parry-Jones, Adrian R.
Smith, Craig J.
Hopkins, Stephen J.
Slevin, Mark
Campi, Veronica
Singh, Puneetpal
Papa, Francesca
Popa-Wagner, Aurel
Tudorica, Valeria
Takagi, Ryo
Teramoto, Akira
Weissenborn, Karin
Lanfermann, Heinrich
Publication Year :
2018
Publisher :
The Lancet Publishing Group, 2018.

Abstract

Background:\ud Intracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography.\ud \ud Methods:\ud In a systematic review of OVID MEDLINE—with additional hand-searching of relevant studies' bibliographies— from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5–24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known.\ud \ud Findings:\ud Of 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56–76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36–0·70; p

Details

Language :
English
ISSN :
14744422
Database :
OpenAIRE
Accession number :
edsair.dedup.wf.001..8083a7d52353ddd04b3b494050930525