Multivariate Analysis of Predictors of Hematoma Enlargement in Spontaneous Intracerebral Hemorrhage

Abstract

Background and Purpose-We conducted this study to determine, through use of multivariate analyses, the independent predictors of hematoma enlargement occurring after hospital admission in patients with spontaneous intracerebral hemorrhage (ICH). Methods-We reviewed 627 patients with ICH admitted within 24 hours of onset. The first CT was performed at admission and the second within 24 hours of admission, and a blood sample was taken for laboratory examinations. Univariate and multivariate analyses were performed to assess the relationships between hematoma enlargement and time from onset, consciousness level, CT findings, amount of alcohol consumption, systolic blood pressure at and after admission, clinical outcome, and hematologic parameters. Hematoma enlargement was an independent factor increasing the mortality rate in the ICH patients (OR, 1.57; PϽ0.001). Conclusions-A particularly high likelihood of hematoma enlargement was observed in patients who (in order of importance) were admitted shortly after onset, who were heavy drinkers; who had an irregularly shaped hematoma, whose consciousness was disturbed, and who had a low level of fibrinogen.

Spontaneous intracerebral hemorrhage: a review

“…81 In several large recent prospective and retrospective studies, investigators have evaluated the rate of hematoma enlargement after initial presentation and report rates ranging from 14 to 38% within the first 24 hours of admission. 19,39,68 In their review of 627 patients with SICH, Fujii, et al, 39 reported that CT scanning within 24 hours of admission demonstrated enlargement of the hematoma in 14% of patients. Five factors were found to be associated with enlargement: admission shortly after onset of symptoms, heavy alcohol consumption, irregularly shaped hematoma, reduced level of consciousness, and low level of fibrinogen.…”

“…39 Opponents, who favor leaving hypertension untreated, argue that preserving CPP is paramount to areas in the ischemic penumbra. Although induced hypertension can increase edema in experimental models, hypertension following SICH is not clearly related to the development of edema.…”

Treatment Targets in Intracerebral Hemorrhage

“…The majority of the initial neurological deficit is due to the hematoma. Previously, early neurological decline was attributed to the development of edema; however, several authors have shown that early decline in neurological status can also be attributed to hematoma expansion (HE) [47][48][49][50][51]. One study enrolled 103 patients with ICH and performed computed tomographic (CT) scans 3 hours after symptom onset and follow-up computed tomographic scans after 1 h and 20 h. There was a 33% enlargement in 26% of patients at the 1-hour follow-up scan and an additional 12% had larger hemorrhages at the 20-h scan.…”

“…HE has also been demonstrated in smaller series for as many as 5 and 6 days [52]. Even though early HE and its associated neurological worsening have been clearly demonstrated, the risk factors associated with HE have not been defined in large population studies [47,[49][50][51]. Current efforts are focused on identification of patients who will develop hematoma expansion with clinical, radiographic, or molecular markers.…”

Contrast Extravasation into an Acute Spontaneous Intracerebral Hematoma: Multidetector CT Angiographic Findings and Clinical Implications

“…A hematoma that is enlarging is associated with poor outcome (9 11). The incidence of hematoma enlargement is about 14 20% by computed tomography (CT) (12,13). A previous study showed that active extravasation of contrast into spontaneous ICH is a marker for continued bleeding that is associated with hematoma enlargement, and it is the most significant radiological variable associated with fatality in a multivariate model (3).…”