Prediction of Intracerebral Haemorrhage Expansion with Clinical, Laboratory, Pharmacologic, and Noncontrast Radiographic Variables

Chan, Sheila L.; Conell, Carol; Veerina, Kaivalya T.; Rao, V.; Flint, Alexander C.

doi:10.1111/ijs.12507

Cited by 25 publications

(17 citation statements)

References 33 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although many studies have investigated unadjusted and adjusted associations between a wide variety of clinical, blood, genetic, imaging, and pharmacological factors and the occurrence of intracerebral haemorrhage growth, only a few prediction models have been developed and the predictors used have varied considerably 7, 8, 9, 10, 11, 51. Since 2011, there has been growing interest in use of the spot sign on CT angiography for predicting intracerebral haemorrhage growth,10, 30 but the clinical utility of the small increase in discrimination that resource-intensive advanced vascular imaging adds to simple clinical and imaging predictors that are available worldwide is unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Interest has grown in whether a so-called spot sign due to contrast extravasation on additional angiography at the time of diagnostic imaging is a predictor of intracerebral haemorrhage growth 6 . There are several multivariable prediction models for intracerebral haemorrhage growth,7, 8, 9, 10, 11 but the identified predictors have varied across models, and several have relied on CT angiography, 12 which is not readily available in low-income and middle-income countries. Identifying more accurate predictors of intracerebral haemorrhage growth is recognised to be a research priority 13 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Salman¹,

Frantzias²,

Lee³

et al. 2018

The Lancet Neurology

255

173

View full text Add to dashboard Cite

SummaryBackgroundIntracerebral 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.MethodsIn 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.FindingsOf 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<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46–11·60; p<0·0001), antiplatelet use (1·68, 1·06–2·66; p=0·026), and anticoagulant use (3·48, 1·96–6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75–0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95–6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03–0·07).InterpretationIn this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects i...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Salman¹,

Frantzias²,

Lee³

et al. 2018

The Lancet Neurology

255

173

View full text Add to dashboard Cite

show abstract

“…While, numerous groups have examined the value of other NCCT markers in predicting hemorrhage expansion, 3,8,9,9,19,20 the data regarding their impact on clinical outcome, remains meager. 13 We found that of these other NCCT markers, only hemorrhage irregularity is independently associated with worse functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients

Boulouis

Morotti

Brouwers

et al. 2016

Stroke

View full text Add to dashboard Cite

Background and Purpose Noncontrast CT hypodensities have been shown to be associated with hematoma expansion in intracerebral hemorrhage (ICH), but their impact on functional outcome is yet to be determined. We evaluated whether baseline noncontrast CT hypodensities are associated with poor clinical outcome. Methods We performed a retrospective review of a prospectively collected cohort of consecutive patients with primary ICH presenting to a single academic medical center between1994 and 2016. The presence of CT hypodensities was assessed by two independent raters on the baseline CT. Unfavorable outcome was defined as a modified Rankin score >3 at 90 days. The associations between CT hypodensities and unfavorable outcome were investigated using uni- and multivariable logistic regression models. Results During the study period 1342 patients presented with ICH, and 800 met restrictive inclusion criteria (baseline CT available for review, and 90 day outcome available). 304 (38%) showed hypodensities on CT, and 520 (65%) experienced unfavorable outcome. In univariate analysis, patients with unfavorable outcome were more likely to demonstrate hypodensities (48% vs 20%, p<0.0001). After adjustment for age, admission Glasgow Coma Scale, warfarin use, intraventricular hemorrhage, baseline ICH volume and location, CT hypodensities were independently associated with an increase in the odds of unfavorable outcome (OR 1.70, 95%CI [1.10 – 2.65], p=0.018). Conclusions The presence of noncontract CT hypodensities at baseline independently predicts poor outcome and comes as a useful and widely available addition to our ability to predict ICH patients’ clinical evolution.

show abstract

“…The association between hemorrhage-expansion and global heterogeneity of the hemorrhage, though, was replicated in at least two different settings. 26,33–35 …”

Section: Ncct Biomarkers Of the Risk Of Hemorrhage-expansionmentioning

confidence: 99%

Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion

Boulouis

Morotti

Charidimou

et al. 2017

Stroke

106

View full text Add to dashboard Cite

Prediction of Intracerebral Haemorrhage Expansion with Clinical, Laboratory, Pharmacologic, and Noncontrast Radiographic Variables

Abstract: Clinical and noncontrast radiographic variables only weakly predict hematoma expansion. Examination of other indicators, such as computed tomographic angiography contrast extravasation (the 'spot sign'), may prove more valuable in acute intracerebral haemorrhage care.

Cited by 25 publications

References 33 publications

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

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

Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients

Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion

Contact Info

Product

Resources

About