Factors Associated with Early Deterioration after Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Abstract

Background and PurposeSpontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with a poor prognosis overall. We conducted a systematic review and meta-analysis to identify and describe factors associated with early neurologic deterioration (END) after ICH.MethodsWe sought to identify any factor which could be prognostic in the absence of an intervention. The Cochrane Library, EMBASE, the Global Health Library, and PubMed were searched for primary studies from the years 1966 to 2012 with no restrictions on language or study design. Studies of patients who received a surgical intervention or specific experimental therapies were excluded. END was defined as death, or worsening on a reliable outcome scale within seven days after onset.Results7,172 abstracts were reviewed, 1,579 full-text papers were obtained and screened. 14 studies were identified; including 2088 patients. Indices of ICH severity such as ICH volume (univariate combined OR per ml:1.37, 95%CI: 1.12–1.68), presence of intraventricular hemorrhage (2.95, 95%CI: 1.57–5.55), glucose concentration (per mmol/l: 2.14, 95%CI: 1.03–4.47), fibrinogen concentration (per g/l: 1.83, 95%CI: 1.03–3.25), and d-dimer concentration at hospital admission (per mg/l: 4.19, 95%CI: 1.88–9.34) were significantly associated with END after random-effects analyses. Whereas commonly described risk factors for ICH progression such as blood pressure, history of hypertension, and ICH growth were not.ConclusionsThis study summarizes the evidence to date on early ICH prognosis and highlights that the amount and distribution of the initial bleed at hospital admission may be the most important factors to consider when predicting early clinical outcomes.

Comparative analysis of predictive significance of neuroimaging parameters in patients with spontaneous supratentorial intracerebral hemorrhage

“…In our opinion, a higher prognostic value of septum pellucidum displacement in comparison with pineal gland displacement for the vital prognosis determination is not only due to ICHV influence, but also to the perifocal edema severity and its influence on the outcome of disease in the acute period. The obtained data are consistent with the results of other studies in which the leading role of the primary mechanisms of brain damage (including dislocation syndrome) in the lethal outcome of SSICH in the acute period was proved [9,10,13].…”

“…The informative value of ICH volume in patients with SIVH is inferior to that of IVH volume and AMS as for the vital and functional outcomes prognosis of SSICH in the acute period determination, which accords with the results of other studies which have proved the negative influence of SIVH presence and severity on the SSICH course and outcome in the acute period [5,13,17]. Our study has determined critical value of IVHV (>24.5 mL), which is the predictor of SSICH lethal outcome in the acute period (Se = 84.6 %, Sp = 96.5 %; OR 95 % CI = 1.18 (1.07-1.30), P = 0.0007).…”

Prediction of cerebral hemorrhagic supratentorial stroke acute period outcome on the basis of the assessment of secondary intraventricular hemorrhage severity in the onset of the disease

“…In accordance with the numerous studies, the presence of secondary IVH is an independent predictor of early clinical deterioration and poor outcome in patients with SICH [4,9,10], which suggests the presence of secondary IVH in the spectrum of parameters associated with the acute period outcome of the disease [11].…”

Development and Validation of an Automatic Segmentation Algorithm for Quantification of Intracerebral Hemorrhage

“…Random selection resulted in composition of a contemporary ICH sample regarding age, antithrombotic drugs, treatment, and clot size. [6][7][8][9] Selection did not account for balance of different hematoma locations or occurrence of intraventricular hemorrhage, however, which could have negatively influenced the accuracy of ABC/2 in agreement analysis. Nevertheless, strong agreement of algorithm and manual segmentations simultaneously supports the algorithm's validity, despite a potential selection bias.…”

“…The role of surgery in the treatment of ICH still remains inconclusive, despite recent large randomized trials, however. [3][4][5][6][7][8][9] Part of the controversy about the value of surgical interventions might be explained by the fact that hematoma volume, a key prognostic factor of interest, has rarely been measured in precise volumetric fashion in surgical outcome studies. [10][11][12][13][14] Instead, clot volume is commonly estimated by the formula ABC/2 until today, owing to the unparalleled applicability and time efficiency of this method.…”