Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Abstract

Background Perihaematomal oedema (PHE) expansion rate may be a predictor of outcome after intracerebral haemorrhage (ICH). We determined whether PHE expansion rate in the first 72 hours after ICH predicts outcome, and how it compares against other PHE measures. Methods We included patients from the Virtual International Stroke Trials Archive. We calculated PHE expansion rate using the equation: (PHE at 72 hours- PHE at baseline)/(Time to 72 hour computerized tomography scan – Time to baseline computerized tomography scan). Outcomes of interest were mortality and poor 90-day outcome (modified Rankin Scale score of ≥ 3). Logistic regression was used to assess relationships with outcome. Results A total of 596 patients with ICH were included. At baseline, median haematoma volume was 15.0 mL (IQR: 7.9–29.2) with median PHE volume of 8.7 mL (IQR: 4.5–15.5). Median PHE expansion rate was 0.31 mL/hr (IQR: 0.12–0.55). The odds of mortality were greater with increasing PHE expansion rate (OR: 2.63, CI: 1.10–6.25), while the odds of poor outcome also increased with greater PHE growth (OR: 1.67, CI: 1.28–2.39). Female sex had an inverse relationship with PHE growth, but baseline hematoma volume had a direct correlation. Among other PHE measures, only interval increase in PHE correlated with poor outcome. There was no significant difference between the two measures of PHE volume expansion. Conclusions Rate of PHE growth over 72 hours was an independent predictor of mortality and poor functional outcomes following intracerebral haemorrhage. Baseline haematoma volume and gender appear to influence PHE growth.

Prognostic role of perihematomal edema in intracerebral hemorrhage: a systematic review

“…Baseline PHEAV was found to be a significant predictor for 90-day mortality in Warfarin-related ICH in Levine's study (18). However, Murthy's study showed baseline PHEAV was not significantly associated with mortality at 90 days (23). Meta-analysis of Levine's and Murthy's studies did not find a significant association between baseline PHEAV and mortality at 90 days (OR=0.71, 95%CI 0.29-1.72, p=0.446) ( Figure 3).…”

“…Meta-analysis of Levine's and Murthy's studies did not find a significant association between baseline PHEAV and mortality at 90 days (OR=0.71, 95%CI 0.29-1.72, p=0.446) ( Figure 3). The association between 72h PHEAV and 90-day mortality was assessed in 2 studies (23,40). In Murthy's study, there was no significant association between 72h PHEAV and 90day mortality (23).…”

“…In 21 included studies, 14 studies evaluated functional outcome (1,2,8,11,19,23,30,32,39,40,(45)(46)(47)52). Modified Rankin Scale (mRS) was used in all these 14 studies.…”

“…Barther Index (BI) was adopted in 2 studies (8,45). Death was accessed in 11 studies (2,3,18,21,23,27,35,40,45,47,52). Early neurological deterioration (END) was evaluated in 2 studies (30,36).…”

Statins and perihemorrhagic edema in patients with spontaneous intracerebral hemorrhage

“…PHE in patients with ICH is a promising treatment target with the potential to improve outcomes. [7][8][9][10] However, many studies do not account for timing of aCT, which may confound results. Choosing a study design in which we controlled for CT timing, we here answered the open question whether statins have a primary prophylactic effect on PHE or not.…”