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Randomized Controlled Trial
. 2014 Dec 9;83(24):2232-8.
doi: 10.1212/WNL.0000000000001076. Epub 2014 Nov 5.

The speed of ultraearly hematoma growth in acute intracerebral hemorrhage

Shoichiro Sato  1 , Hisatomi Arima  1 , Yoichiro Hirakawa  1 , Emma Heeley  1 , Candice Delcourt  1 , Ronny Beer  1 , Yuechun Li  1 , Jingfen Zhang  1 , Eric Jüettler  1 , Jiguang Wang  1 , Pablo M Lavados  1 , Thompson Robinson  1 , Richard I Lindley  1 , John Chalmers  1 , Craig S Anderson  2 ; INTERACT Investigators
Affiliations
Randomized Controlled Trial

The speed of ultraearly hematoma growth in acute intracerebral hemorrhage

Shoichiro Sato et al. Neurology. .

Abstract

Objective: The prognostic importance of the speed of early hematoma growth in acute intracerebral hemorrhage (ICH) has not been well established. We aimed to determine the association between the rate of increase in hematoma volume and major clinical outcomes in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. The effects of early intensive blood pressure (BP) lowering according to the speed of hematoma growth were also investigated.

Methods: Pooled analyses of the INTERACT1 (n = 404) and INTERACT2 (n = 2,839) studies-randomized controlled trials of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. The speed of ultraearly hematoma growth (UHG) was defined as hematoma volume (mL)/onset-to-CT time (hours). Primary outcome was death or major disability (modified Rankin Scale score of 3-6) at 90 days.

Results: Among a total of 2,909 patients (90%) with information on UHG and outcome, median speed of UHG was 6.2 mL/h. There was a linear association between UHG and outcome: multivariable-adjusted odd ratios 1.90 (95% confidence interval 1.50-2.39) for 5-10 mL/h and 2.96 (2.36-3.71) for >10 mL/h vs the <5 mL/h group. There were no clear differences in the effects of intensive BP lowering according to 3 speeds of UHG on outcome (p = 0.75 for homogeneity).

Conclusions: The speed of UHG in patients with ICH was continuously associated with increased risks of death or major disability, and from lower levels than previously reported (≥5 mL/h). The benefits of intensive BP lowering appear to be independent of the speed of bleeding.

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Figures

Figure 1
Figure 1. Association between UHG and clinical outcomes
Association between UHG and clinical outcomes according to death or major disability (A), death (B), and major disability (C). Solid boxes represent odds ratio, and vertical lines 95% CI; <5 (mL/h) is reference. Results were adjusted for age, sex, region, diabetes, blood pressure–lowering therapy, antithrombotic therapy, systolic blood pressure, glucose, high score (≥14) on the NIH Stroke Scale, hematoma location, intraventricular extension, trial, and randomized treatment. CI = confidence interval; UHG = ultraearly hematoma growth.
Figure 2
Figure 2. Treatment effects on (A) death or major disability, and (B) absolute hematoma growth by UHG speeds
Solid boxes represent estimates of treatment effect; horizontal lines, 95% CI; a diamond, the estimate and 95% CI for overall effect. (A) Areas of the boxes are proportional number of outcomes. Results were adjusted for trials. (B) Areas of the boxes are proportional to the reciprocal of the variance of estimates. Results were adjusted for trials and hematoma location. CI = confidence interval; UHG = ultraearly hematoma growth.
See this image and copyright information in PMC

References

    1. Rodriguez-Luna D, Rubiera M, Ribo M, et al. Ultraearly hematoma growth predicts poor outcome after acute intracerebral hemorrhage. Neurology 2011;77:1599–1604. - PubMed
    1. Anderson CS, Huang Y, Wang JG, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 2008;7:391–399. - PubMed
    1. Delcourt C, Huang Y, Wang J, et al. The second (main) phase of an open, randomised, multicentre study to investigate the effectiveness of an intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT2). Int J Stroke 2010;5:110–116. - PubMed
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