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Comparative Study
. 2013 Aug;70(8):988-94.
doi: 10.1001/jamaneurol.2013.98.

Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage

Guido J Falcone  1 , Alessandro Biffi, H Bart Brouwers, Christopher D Anderson, Thomas W K Battey, Alison M Ayres, Anastasia Vashkevich, Kristin Schwab, Natalia S Rost, Joshua N Goldstein, Anand Viswanathan, Steven M Greenberg, Jonathan Rosand
Affiliations
Comparative Study

Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage

Guido J Falcone et al. JAMA Neurol. 2013 Aug.

Abstract

Importance: Hematoma volume is the strongest predictor of outcome in intracerebral hemorrhage (ICH). Despite known differences in the underlying biology between deep and lobar ICHs, limited data are available on location specificity of factors reported to affect hematoma volume.

Objective: To evaluate whether determinants of ICH volume differ by topography, we sought to estimate location-specific effects for potential predictors of this radiological outcome.

Design: Prospective cohort study.

Setting: Academic medical center.

Participants: A total of 744 supratentorial primary ICH patients (388 deep and 356 lobar) aged older than 18 years admitted between January 1, 2000, and December 31, 2010.

Main outcomes and measures: Intracerebral hemorrhage volume measured from the computed tomography scan obtained on presentation to the emergency department. Linear regression analysis, stratified by ICH location, was implemented to identify determinants of log-transformed ICH volume.

Results: Median ICH volume was larger in lobar hemorrhages (39 mL; interquartile range, 16-75 mL) than in deep hemorrhages (13 mL; interquartile range, 5-40 mL; P < .001). In multivariable linear regression, independent predictors of deep ICH volume were intensity of anticoagulation (β = 0.32; standard error [SE] = 0.08; P < .001; test for trend across 4 categories of the international normalized ratio), history of coronary artery disease (β = 0.33; SE = 0.17; P = .05), male sex (β = 0.28; SE = 0.14; P = .05), and age (β = -0.02; SE = 0.01; P = .001). Independent predictors of lobar ICH volume were intensity of anticoagulation (β = 0.14; SE = 0.06; P = .02) and antiplatelet treatment (β = 0.27; SE = 0.13; P = .03).

Conclusions and relevance: Predictors of hematoma volume only partially overlap between deep and lobar ICHs. These findings suggest that the mechanisms that determine the extent of bleeding differ for deep and lobar ICHs. Further studies are needed to characterize the specific biological pathways that underlie the observed associations.

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Figures

Figure
Figure
Predicted intracerebral hemorrhage (ICH) volume by international normalized ratio (INR) categories. Predicted log-mean hematoma volume applying the fitted models. Results are presented stratified by INR category and by ICH location.
See this image and copyright information in PMC

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