Early Deterioration and Long-Term Prognosis of Patients With Intracerebral Hemorrhage Along With Hematoma Volume More Than 20 ml: Who Needs Surgery?

Abstract

Background and Purpose: The treatment of patients with intracerebral hemorrhage along with moderate hematoma and without cerebral hernia is controversial. This study aimed to explore risk factors and establish prediction models for early deterioration and poor prognosis.Methods: We screened patients from the prospective intracerebral hemorrhage (ICH) registration database (RIS-MIS-ICH, ClinicalTrials.gov Identifier: NCT03862729). The enrolled patients had no brain hernia at admission, with a hematoma volume of more than 20 ml. All patients were initially treated by conservative methods and followed up ≥ 1 year. A decline of Glasgow Coma Scale (GCS) more than 2 or conversion to surgery within 72 h after admission was defined as early deterioration. Modified Rankin Scale (mRS) ≥ 4 at 1 year after stroke was defined as poor prognosis. The independent risk factors of early deterioration and poor prognosis were determined by univariate and multivariate regression analysis. The prediction models were established based on the weight of the independent risk factors. The accuracy and value of models were tested by the receiver operating characteristic (ROC) curve.Results: After screening 632 patients with ICH, a total of 123 legal patients were included. According to statistical analysis, admission GCS (OR, 1.43; 95% CI, 1.18–1.74; P < 0.001) and hematoma volume (OR, 0.9; 95% CI, 0.84–0.97; P = 0.003) were the independent risk factors for early deterioration. Hematoma location (OR, 0.027; 95% CI, 0.004–0.17; P < 0.001) and hematoma volume (OR, 1.09; 95% CI, 1.03–1.15; P < 0.001) were the independent risk factors for poor prognosis, and island sign had a trend toward significance (OR, 0.5; 95% CI, 0.16-1.57; P = 0.051). The admission GCS and hematoma volume score were combined for an early deterioration prediction model with a score from 2 to 5. ROC curve showed an area under the curve (AUC) was 0.778 and cut-off point was 3.5. Combining the score of hematoma volume, island sign, and hematoma location, a long-term prognosis prediction model was established with a score from 2 to 6. ROC curve showed AUC was 0.792 and cutoff point was 4.5.Conclusions: The novel early deterioration and long-term prognosis prediction models are simple, objective, and accurate for patients with ICH along with a hematoma volume of more than 20 ml.

Determining the optimal hematoma volume-based thresholds for surgical and medical strategies in basal ganglia hemorrhage

“…Several papers were developed outlining the criteria for surgery in ICH (7,29,30,31,32,33) . Key factors considered included the hematoma volume, GCS, and midline shift.…”

Irregular shape as an independent predictor of prognosis in patients with primary intracerebral hemorrhage

“…In which the predictive power of irregular shapes was the best. In addition, many studies have demonstrated the significant value of hematoma volume for the prediction of prognostic situations in patients with intracerebral hemorrhage 20 – 23 . In our study, initial hematoma volume predicted poor functional outcomes in patients than irregularly shaped hematomas.…”

Role of complement C1q/C3-CR3 signaling in brain injury after experimental intracerebral hemorrhage and the effect of minocycline treatment

“…Extravasated blood initiates the coagulation cascade and a hematoma subsequently forms ( 2 , 3 ). The size of the hematoma is an independent risk factor for early deterioration and long-term prognosis in ICH patients ( 4 ). The hematoma has the initial mass effect and subsequent injury response by releasing hemoglobin and degradation products.…”