Intracerebral Hemorrhage Location and Functional Outcomes of Patients: A Systematic Literature Review and Meta-Analysis

Sreekrishnan, Anirudh; Dearborn, Jennifer L.; Greer, David M.; Shi, Fu‐Dong; Hwang, David Y.; Leasure, Audrey C; Zhou, Sonya E.; Gilmore, Emily J.; Matouk, Charles; Petersen, Nils; Sansing, Lauren H; Sheth, Kevin N

doi:10.1007/s12028-016-0276-4

Cited by 63 publications

(49 citation statements)

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“…To directly compare differences between the mRS and BI, percentages of “good outcomes” were calculated using mRS < 3 and BI ≥ 85 as respective cut-offs. Cut-offs of good outcome were chosen based on their commonality within ICH research and clinical trials[16,18,19]. To specifically assess significant differences in the distribution of mRS scores (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…BI ≥ 95) at 100 days post-injury[15]; however, to our knowledge the BI has not been used to evaluate survivors beyond this time-point in any prospective observational ICH study. Additionally, while the mRS is commonly used to assess outcome in ICH patients[16], there has been little focus on understanding the burden of disability at various time-points. As new interventions for ICH patients are being developed, choosing proper end-points as well as clinically relevant assessments are important for well-designed trials.…”

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confidence: 99%

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Functional Improvement Among Intracerebral Hemorrhage (ICH) Survivors up to 12 Months Post-injury

et al. 2017

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Background and Purpose As survival rates have increased for intracerebral hemorrhage (ICH) patients, there is limited information regarding recovery beyond three to six months. This study was conducted to examine recovery curves using the modified Rankin Scale (mRS) and Barthel Index (BI) up to 12 months post-injury. Methods We prospectively enrolled 173 patients admitted with ICH who were subsequently evaluated using the mRS and BI at discharge as well as three, six, and 12 months. Repeated-measures non-parametric testing were conducted to assess functional trajectories across time. Results The mRS scores showed significant improvement between discharge (median: 4) and three (median: 4), six (median: 4), and 12 months (median: 3) (p values < 0.001). However, the mRS scores did not differ between follow-up time-points (i.e. three to six months, six to 12 months, etc.). There was significant improvement in scores using the BI (p values < 0.001), showing improvement between discharge (mean: 43.0) and three (mean: 73.0), six (mean: 78.2), and 12 months (mean: 83.4). Additionally there were differences on the BI between three and 12 months (p = 0.013), as well as between six and 12 months (p = 0.025). Conclusions The BI may be a more sensitive measure of long-term recovery post-injury than the mRS, which shows minimal improvement for some survivors after three months. BI scores indicate survivors continually improve till 12 months post-injury. These results may have implications for the prognostication of ICH and design of clinical trial outcome measures.

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Functional Improvement Among Intracerebral Hemorrhage (ICH) Survivors up to 12 Months Post-injury

et al. 2017

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“…In this regard, one has to keep in mind that various previous studies of ICH used different definitions of deep and lobar ICH. 10,11,15 Nonetheless, the retrospective and singlecenter design as well as the small sample size in each group undermined further statistical adjusting to minimize volumerelated effects on outcome. Furthermore, we may have missed specific ICH causes that were unmasked on follow-up imaging after hospital discharge as these imaging findings were not assessed.…”

Section: March 2017mentioning

confidence: 99%

“…[3][4][5] In supratentorial ICH, comparison of patients with lobar and deep ICH revealed outcome benefits for patients with lobar ICH. [6][7][8][9][10][11] However, within lobar ICH, a specific comparison on affected lobe and clinical outcome is lacking.…”

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Specific Lobar Affection Reveals a Rostrocaudal Gradient in Functional Outcome in Spontaneous Intracerebral Hemorrhage

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Kuramatsu

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et al. 2017

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Between 2008 and 2012, all consecutive patients with atraumatic ICH admitted to the Department of Neurology of the university hospital Background and Purpose-Several studies have reported a better functional outcome in lobar intracerebral hemorrhage (ICH) compared with deep location. However, among lobar ICH, a correlation of hemorrhage site-involving the specific lobes-with functional outcome has not been established. Methods-Conservatively treated patients with supratentorial ICH, admitted to our hospital over a 5-year period (2008)(2009)(2010)(2011)(2012), were retrospectively analyzed. Lobar patients were classified as isolated or overlapping ICH according to affected lobes. Demographic, clinical, and radiological characteristics were recorded and compared among lobar ICH patients using above subclassification. Functional outcome-dichotomized into favorable (modified Rankin Scale, 0-3) and unfavorable (modified Rankin Scale, 4-6)-was assessed after 3 and 12 months. Multivariate regression analysis was performed to identify predictors for favorable outcome.

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Association of Intensive Blood Pressure Reduction With Risk of Hematoma Expansion in Patients With Deep Intracerebral Hemorrhage

et al. 2019

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IMPORTANCE Hypertension is the strongest risk factor for spontaneous intracerebral hemorrhage (ICH) involving deep brain regions, but it appears to be unknown if intensive blood pressure reduction in the acute care setting decreases hematoma expansion or improves outcomes in patients with deep ICH. OBJECTIVE To determine whether intensive blood pressure reduction is associated with decreased risk of hematoma expansion and changes in 90-day modified Rankin Scale scores and if these associations are modified by the specific deep-brain nuclei involved. DESIGN, SETTING, AND PARTICIPANTS This study is an exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage-2 international, multicenter randomized clinical trial, which was conducted from May 2011 to September 2015, enrolled eligible patients with primary ICH, and followed up with them for 90 days. Patients who had ICH and complete neuroimaging data were included in the analysis. Data analysis was completed from July 2018 to December 2018. EXPOSURES Participants were randomized to either intensive treatment (with a systolic blood pressure target of 110-139 mm Hg) or standard treatment (with a systolic blood pressure target of 140-179 mm Hg). MAIN OUTCOMES AND MEASURES The main outcome was hematoma expansion, defined as an increase greater than 33% in hematoma volume between baseline and 24 hours. Functional outcome was evaluated 90 days after the ICH via the modified Rankin Scale. RESULTS Of 1000 trial participants, 870 (87.0%) had deep ICH, of whom 780 (89.7%) had complete neuroimaging data (of 336 thalamic and 444 basal ganglia hemorrhages). The baseline characteristics of the intensive and standard treatment groups remained balanced in this subgroup of the original study. Intensive treatment was associated with a decreased risk of hematoma expansion in univariable analysis (odds ratio [OR], 0.62 [95% CI, 0.43-0.87]; P = .006) and multivariable analysis (OR, 0.61 [95% CI, 0.42-0.88]; P = .009). This association was modified by the specific deep location of the ICH (OR, 0.44 [95% CI, 0.22-0.96]; interaction P = .02), with stratified analyses showing a reduction in risk of hematoma expansion with intensive vs standard treatment among basal ganglia ICH (OR, 0.44 [95% CI, 0.27-0.72]; P = .001) but not thalamic ICH (OR, 0.91 [95% CI, 0.51-0.64]; P = .76). Intensive treatment was not associated with an improvement in the modified Rankin Scale score distribution. CONCLUSIONS AND RELEVANCE Compared with standard treatment, intensive blood pressure treatment was associated with reduced hematoma expansion in deep ICH, specifically among basal ganglia hemorrhages.

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Intracerebral Hemorrhage Location and Functional Outcomes of Patients: A Systematic Literature Review and Meta-Analysis

Cited by 63 publications

References 43 publications

Functional Improvement Among Intracerebral Hemorrhage (ICH) Survivors up to 12 Months Post-injury

Functional Improvement Among Intracerebral Hemorrhage (ICH) Survivors up to 12 Months Post-injury

Specific Lobar Affection Reveals a Rostrocaudal Gradient in Functional Outcome in Spontaneous Intracerebral Hemorrhage

Association of Intensive Blood Pressure Reduction With Risk of Hematoma Expansion in Patients With Deep Intracerebral Hemorrhage

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