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Multicenter Study
. 2014 Feb;71(2):158-64.
doi: 10.1001/jamaneurol.2013.5433.

Predicting hematoma expansion after primary intracerebral hemorrhage

H Bart Brouwers  1 , Yuchiao Chang  2 , Guido J Falcone  1 , Xuemei Cai  3 , Alison M Ayres  4 , Thomas W K Battey  5 , Anastasia Vashkevich  4 , Kristen A McNamara  4 , Valerie Valant  5 , Kristin Schwab  4 , Susannah C Orzell  3 , Linda M Bresette  3 , Steven K Feske  3 , Natalia S Rost  1 , Javier M Romero  6 , Anand Viswanathan  7 , Sherry H-Y Chou  3 , Steven M Greenberg  4 , Jonathan Rosand  1 , Joshua N Goldstein  7
Affiliations
Multicenter Study

Predicting hematoma expansion after primary intracerebral hemorrhage

H Bart Brouwers et al. JAMA Neurol. 2014 Feb.

Abstract

Importance: Many clinical trials focus on restricting hematoma expansion following acute intracerebral hemorrhage (ICH), but selecting those patients at highest risk of hematoma expansion is challenging.

Objective: To develop a prediction score for hematoma expansion in patients with primary ICH.

Design, setting, and participants: Prospective cohort study at 2 urban academic medical centers among patients having primary ICH with available baseline and follow-up computed tomography for volumetric analysis (817 patients in the development cohort and 195 patients in the independent validation cohort).

Main outcomes and measures: Hematoma expansion was assessed using semiautomated software and was defined as more than 6 mL or 33% growth. Covariates were tested for association with hematoma expansion using univariate and multivariable logistic regression. A 9-point prediction score was derived based on the regression estimates and was subsequently tested in the independent validation cohort.

Results: Hematoma expansion occurred in 156 patients (19.1%). In multivariable analysis, predictors of expansion were as follows: warfarin sodium use, the computed tomography angiography spot sign, and shorter time to computed tomography (≤ 6 vs >6 hours) (P < .001 for all), as well as baseline ICH volume (<30 [reference], 30-60 [P = .03], and >60 [P = .005] mL). The incidence of hematoma expansion steadily increased with higher scores. In the independent validation cohort (n = 195), our prediction score performed well and showed strong association with hematoma expansion (odds ratio, 4.59; P < .001 for a high vs low score). The C statistics for the score were 0.72 for the development cohort and 0.77 for the independent validation cohort.

Conclusions and relevance: A 9-point prediction score for hematoma expansion was developed and independently validated. The results open a path for individualized treatment and trial design in ICH aimed at patients at highest risk of hematoma expansion with maximum potential for therapeutic benefit.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rost is the recipient of a research grant from the National Institute of Neurological Disorders and Stroke (NINDH), National Institutes of Health (NIH). Dr Romero reported serving on the imaging committee of the Desmoteplase in Acute Ischemic Stroke trial and on the advisory board of Lundbeck Pharmaceuticals. Dr Chou is the recipient of research grants from the NIH and the American Heart Association and participates in an end point committee of a clinical trial by Novartis. Dr Greenberg is the recipient of a research grant from the NIH. Dr Rosand is the recipient of a research grant from the NIH and reported serving as a consultant to Boehringer Ingelheim. Dr Goldstein is the recipient of a research grant from the NINDS and reported serving as a consultant to and on the advisory board of CSL Behring. No other disclosures were reported.

References

    1. Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet. 2009;373(9675):1632–1644. - PMC - PubMed
    1. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167–176. - PubMed
    1. Delcourt C, Huang Y, Arima H, et al. INTERACT1 Investigators. Hematoma growth and outcomes in intracerebral hemorrhage: the INTERACT1 study. Neurology. 2012;79(4):314–319. - PubMed
    1. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage: a powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24(7):987–993. - PubMed
    1. Flaherty ML, Haverbusch M, Sekar P, et al. Long-term mortality after intracerebral hemorrhage. Neurology. 2006;66(8):1182–1186. - PubMed

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