Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume
Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE. This was a retrospective analysis of patients with ICH admitted...
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creator | Morotti, Andrea Boulouis, Gregoire Nawabi, Jawed Li, Qi Charidimou, Andreas Pasi, Marco Schlunk, Frieder Shoamanesh, Ashkan Katsanos, Aristeidis H Mazzacane, Federico Busto, Giorgio Arba, Francesco Brancaleoni, Laura Giacomozzi, Sebastiano Simonetti, Luigi Warren, Andrew D Laudisi, Michele Cavallini, Anna Gurol, M Edip Viswanathan, Anand Zini, Andrea Casetta, Ilaria Fainardi, Enrico Greenberg, Steven M Padovani, Alessandro Rosand, Jonathan Goldstein, Joshua N |
description | Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE.
This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (66%). Absolute HE (aHE) was classified as none (12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4-6) were explored with logistic regression.
We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%,
< 0.001 and 18.3% vs 7.2%,
< 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38-2.82,
< 0.001; aHE OR 1.73, 95% CI 1.23-2.45,
= 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL.
The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies. |
doi_str_mv | 10.1212/WNL.0000000000207728 |
format | Article |
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This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (<0%), mild (0%-33%), moderate (33.1%-66%), and severe (>66%). Absolute HE (aHE) was classified as none (<0 mL), mild (0-6.0 mL), moderate (6.1-12.5 mL), and severe (>12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4-6) were explored with logistic regression.
We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%,
< 0.001 and 18.3% vs 7.2%,
< 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38-2.82,
< 0.001; aHE OR 1.73, 95% CI 1.23-2.45,
= 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL.
The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies.</description><identifier>ISSN: 0028-3878</identifier><identifier>ISSN: 1526-632X</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000207728</identifier><identifier>PMID: 37604661</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Cerebral Hemorrhage - drug therapy ; Cerebral Hemorrhage - therapy ; Hematoma - drug therapy ; Hematoma - therapy ; Humans ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed</subject><ispartof>Neurology, 2023-10, Vol.101 (16), p.e1606-e1613</ispartof><rights>2023 American Academy of Neurology.</rights><rights>2023 American Academy of Neurology 2023 American Academy of Neurology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c363t-1fbc0e9dd4f5650aee803bd85d60a0d1ad3d13fed9506c96c811980091cedc353</citedby><cites>FETCH-LOGICAL-c363t-1fbc0e9dd4f5650aee803bd85d60a0d1ad3d13fed9506c96c811980091cedc353</cites><orcidid>0000-0002-6406-1828 ; 0000-0001-8422-9205 ; 0000-0002-9144-148X ; 0000-0002-6558-1155 ; 0000-0003-3941-7383 ; 0000-0003-1792-8887 ; 0000-0001-5891-337X ; 0000-0001-9976-2459</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37604661$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morotti, Andrea</creatorcontrib><creatorcontrib>Boulouis, Gregoire</creatorcontrib><creatorcontrib>Nawabi, Jawed</creatorcontrib><creatorcontrib>Li, Qi</creatorcontrib><creatorcontrib>Charidimou, Andreas</creatorcontrib><creatorcontrib>Pasi, Marco</creatorcontrib><creatorcontrib>Schlunk, Frieder</creatorcontrib><creatorcontrib>Shoamanesh, Ashkan</creatorcontrib><creatorcontrib>Katsanos, Aristeidis H</creatorcontrib><creatorcontrib>Mazzacane, Federico</creatorcontrib><creatorcontrib>Busto, Giorgio</creatorcontrib><creatorcontrib>Arba, Francesco</creatorcontrib><creatorcontrib>Brancaleoni, Laura</creatorcontrib><creatorcontrib>Giacomozzi, Sebastiano</creatorcontrib><creatorcontrib>Simonetti, Luigi</creatorcontrib><creatorcontrib>Warren, Andrew D</creatorcontrib><creatorcontrib>Laudisi, Michele</creatorcontrib><creatorcontrib>Cavallini, Anna</creatorcontrib><creatorcontrib>Gurol, M Edip</creatorcontrib><creatorcontrib>Viswanathan, Anand</creatorcontrib><creatorcontrib>Zini, Andrea</creatorcontrib><creatorcontrib>Casetta, Ilaria</creatorcontrib><creatorcontrib>Fainardi, Enrico</creatorcontrib><creatorcontrib>Greenberg, Steven M</creatorcontrib><creatorcontrib>Padovani, Alessandro</creatorcontrib><creatorcontrib>Rosand, Jonathan</creatorcontrib><creatorcontrib>Goldstein, Joshua N</creatorcontrib><title>Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume</title><title>Neurology</title><addtitle>Neurology</addtitle><description>Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE.
This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (<0%), mild (0%-33%), moderate (33.1%-66%), and severe (>66%). Absolute HE (aHE) was classified as none (<0 mL), mild (0-6.0 mL), moderate (6.1-12.5 mL), and severe (>12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4-6) were explored with logistic regression.
We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%,
< 0.001 and 18.3% vs 7.2%,
< 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38-2.82,
< 0.001; aHE OR 1.73, 95% CI 1.23-2.45,
= 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL.
The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies.</description><subject>Cerebral Hemorrhage - drug therapy</subject><subject>Cerebral Hemorrhage - therapy</subject><subject>Hematoma - drug therapy</subject><subject>Hematoma - therapy</subject><subject>Humans</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed</subject><issn>0028-3878</issn><issn>1526-632X</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1P4zAQhi0EgsLyDxDKkUtYO64d54QAwbZSBYeFhZvl2hNqlMTFdmB74L-vw0cF64uteWcej_QgdEDwMSlI8fPuanaM16fAZVmIDTQirOA5p8X9JhqlssipKMUO2g3hEeMUltU22qElx2POyQi9nobgtFXRui47g_gC0GUTaFV0rcou_i5VF4boNzyDt3GVqc5k133UroW39zSGbNpF8Eq_Me5sXGRnKkBjOxiSFICHuVfNwHXeL9QDZH9c07fwA23Vqgmw_3HvodvLi5vzST67_jU9P53lmnIac1LPNYbKmHHNOMMKQGA6N4IZjhU2RBlqCK3BVAxzXXEtCKkExhXRYDRldA-dvHOX_bxNJRjWauTS21b5lXTKyu9JZxfywT1LgplgvBSJcPRB8O6phxBla4OGplEduD7IQrBxxZMDklrH763auxA81Ot_CJaDOpnUyf_VpbHDrzuuhz5d0X8fbZg0</recordid><startdate>20231017</startdate><enddate>20231017</enddate><creator>Morotti, Andrea</creator><creator>Boulouis, Gregoire</creator><creator>Nawabi, Jawed</creator><creator>Li, Qi</creator><creator>Charidimou, Andreas</creator><creator>Pasi, Marco</creator><creator>Schlunk, Frieder</creator><creator>Shoamanesh, Ashkan</creator><creator>Katsanos, Aristeidis H</creator><creator>Mazzacane, Federico</creator><creator>Busto, Giorgio</creator><creator>Arba, Francesco</creator><creator>Brancaleoni, Laura</creator><creator>Giacomozzi, Sebastiano</creator><creator>Simonetti, Luigi</creator><creator>Warren, Andrew D</creator><creator>Laudisi, Michele</creator><creator>Cavallini, Anna</creator><creator>Gurol, M Edip</creator><creator>Viswanathan, Anand</creator><creator>Zini, Andrea</creator><creator>Casetta, Ilaria</creator><creator>Fainardi, Enrico</creator><creator>Greenberg, Steven M</creator><creator>Padovani, Alessandro</creator><creator>Rosand, Jonathan</creator><creator>Goldstein, Joshua N</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6406-1828</orcidid><orcidid>https://orcid.org/0000-0001-8422-9205</orcidid><orcidid>https://orcid.org/0000-0002-9144-148X</orcidid><orcidid>https://orcid.org/0000-0002-6558-1155</orcidid><orcidid>https://orcid.org/0000-0003-3941-7383</orcidid><orcidid>https://orcid.org/0000-0003-1792-8887</orcidid><orcidid>https://orcid.org/0000-0001-5891-337X</orcidid><orcidid>https://orcid.org/0000-0001-9976-2459</orcidid></search><sort><creationdate>20231017</creationdate><title>Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume</title><author>Morotti, Andrea ; Boulouis, Gregoire ; Nawabi, Jawed ; Li, Qi ; Charidimou, Andreas ; Pasi, Marco ; Schlunk, Frieder ; Shoamanesh, Ashkan ; Katsanos, Aristeidis H ; Mazzacane, Federico ; Busto, Giorgio ; Arba, Francesco ; Brancaleoni, Laura ; Giacomozzi, Sebastiano ; Simonetti, Luigi ; Warren, Andrew D ; Laudisi, Michele ; Cavallini, Anna ; Gurol, M Edip ; Viswanathan, Anand ; Zini, Andrea ; Casetta, Ilaria ; Fainardi, Enrico ; Greenberg, Steven M ; Padovani, Alessandro ; Rosand, Jonathan ; Goldstein, Joshua N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c363t-1fbc0e9dd4f5650aee803bd85d60a0d1ad3d13fed9506c96c811980091cedc353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cerebral Hemorrhage - drug therapy</topic><topic>Cerebral Hemorrhage - therapy</topic><topic>Hematoma - drug therapy</topic><topic>Hematoma - therapy</topic><topic>Humans</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morotti, Andrea</creatorcontrib><creatorcontrib>Boulouis, Gregoire</creatorcontrib><creatorcontrib>Nawabi, Jawed</creatorcontrib><creatorcontrib>Li, Qi</creatorcontrib><creatorcontrib>Charidimou, Andreas</creatorcontrib><creatorcontrib>Pasi, Marco</creatorcontrib><creatorcontrib>Schlunk, Frieder</creatorcontrib><creatorcontrib>Shoamanesh, Ashkan</creatorcontrib><creatorcontrib>Katsanos, Aristeidis H</creatorcontrib><creatorcontrib>Mazzacane, Federico</creatorcontrib><creatorcontrib>Busto, Giorgio</creatorcontrib><creatorcontrib>Arba, Francesco</creatorcontrib><creatorcontrib>Brancaleoni, Laura</creatorcontrib><creatorcontrib>Giacomozzi, Sebastiano</creatorcontrib><creatorcontrib>Simonetti, Luigi</creatorcontrib><creatorcontrib>Warren, Andrew D</creatorcontrib><creatorcontrib>Laudisi, Michele</creatorcontrib><creatorcontrib>Cavallini, Anna</creatorcontrib><creatorcontrib>Gurol, M Edip</creatorcontrib><creatorcontrib>Viswanathan, Anand</creatorcontrib><creatorcontrib>Zini, Andrea</creatorcontrib><creatorcontrib>Casetta, Ilaria</creatorcontrib><creatorcontrib>Fainardi, Enrico</creatorcontrib><creatorcontrib>Greenberg, Steven M</creatorcontrib><creatorcontrib>Padovani, Alessandro</creatorcontrib><creatorcontrib>Rosand, Jonathan</creatorcontrib><creatorcontrib>Goldstein, Joshua N</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morotti, Andrea</au><au>Boulouis, Gregoire</au><au>Nawabi, Jawed</au><au>Li, Qi</au><au>Charidimou, Andreas</au><au>Pasi, Marco</au><au>Schlunk, Frieder</au><au>Shoamanesh, Ashkan</au><au>Katsanos, Aristeidis H</au><au>Mazzacane, Federico</au><au>Busto, Giorgio</au><au>Arba, Francesco</au><au>Brancaleoni, Laura</au><au>Giacomozzi, Sebastiano</au><au>Simonetti, Luigi</au><au>Warren, Andrew D</au><au>Laudisi, Michele</au><au>Cavallini, Anna</au><au>Gurol, M Edip</au><au>Viswanathan, Anand</au><au>Zini, Andrea</au><au>Casetta, Ilaria</au><au>Fainardi, Enrico</au><au>Greenberg, Steven M</au><au>Padovani, Alessandro</au><au>Rosand, Jonathan</au><au>Goldstein, Joshua N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2023-10-17</date><risdate>2023</risdate><volume>101</volume><issue>16</issue><spage>e1606</spage><epage>e1613</epage><pages>e1606-e1613</pages><issn>0028-3878</issn><issn>1526-632X</issn><eissn>1526-632X</eissn><abstract>Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE.
This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (<0%), mild (0%-33%), moderate (33.1%-66%), and severe (>66%). Absolute HE (aHE) was classified as none (<0 mL), mild (0-6.0 mL), moderate (6.1-12.5 mL), and severe (>12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4-6) were explored with logistic regression.
We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%,
< 0.001 and 18.3% vs 7.2%,
< 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38-2.82,
< 0.001; aHE OR 1.73, 95% CI 1.23-2.45,
= 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL.
The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>37604661</pmid><doi>10.1212/WNL.0000000000207728</doi><orcidid>https://orcid.org/0000-0002-6406-1828</orcidid><orcidid>https://orcid.org/0000-0001-8422-9205</orcidid><orcidid>https://orcid.org/0000-0002-9144-148X</orcidid><orcidid>https://orcid.org/0000-0002-6558-1155</orcidid><orcidid>https://orcid.org/0000-0003-3941-7383</orcidid><orcidid>https://orcid.org/0000-0003-1792-8887</orcidid><orcidid>https://orcid.org/0000-0001-5891-337X</orcidid><orcidid>https://orcid.org/0000-0001-9976-2459</orcidid></addata></record> |
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subjects | Cerebral Hemorrhage - drug therapy Cerebral Hemorrhage - therapy Hematoma - drug therapy Hematoma - therapy Humans Prognosis Retrospective Studies Tomography, X-Ray Computed |
title | Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume |
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