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. 2023 May 5:14:1122744.
doi: 10.3389/fneur.2023.1122744. eCollection 2023.

Cortical superficial siderosis, hematoma volume, and outcomes after intracerebral hemorrhage: a mediation analysis

Yu-Jia Jin #  1 , Jia-Wen Li #  1 , Jian Wu  1 , Yu-Hui Huang  2 , Kai-Cheng Yang  1 , Hong-Na An  3 , Chang-Zheng Yuan  2 , Feng Gao  1 , Lu-Sha Tong  1
Affiliations

Cortical superficial siderosis, hematoma volume, and outcomes after intracerebral hemorrhage: a mediation analysis

Yu-Jia Jin et al. Front Neurol. .

Abstract

Background: Previous studies have shown that cortical superficial siderosis (cSS) can increase hematoma volume and predict poor outcomes following primary intracerebral hemorrhage (ICH).

Objective: We aimed to determine whether a large hematoma volume was the essential factor contributing to worse outcomes of cSS.

Methods: Patients with spontaneous ICH underwent a CT scan within 48 h after ictus. Evaluation of cSS was performed using magnetic resonance imaging (MRI) within 7 days. The 90-day outcome was assessed using the modified Rankin Scale (mRS). In addition, we investigated the correlation between cSS, hematoma volume, and 90-day outcomes using multivariate regression and mediation analyses.

Results: Among the 673 patients with ICH [mean (SD) age, 61 (13) years; 237 female subjects (35.2%); median (IQR) hematoma volume, 9.0 (3.0-17.6) ml], 131 (19.5%) had cSS. There was an association between cSS and larger hematoma volume (β = 4.449, 95% CI 1.890-7.009, p < 0.001) independent of hematoma location and was also related to worse 90-day mRS (β = 0.333, 95% CI 0.008-0.659, p = 0.045) in multivariable regression. In addition, mediation analyses revealed that hematoma volume was an essential factor mediating the effect of cSS on unfavorable 90-day outcomes (proportion mediated:66.04%, p = 0.01).

Conclusion: Large hematoma volume was the major charge of directing cSS to worse outcomes in patients with mild to moderate ICH, and cSS was related to a larger hematoma in both lobar and non-lobar areas.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04803292, identifier: NCT04803292.

Keywords: ICH volume and outcome; cSS; cerebral hemorrhage; hematoma; mediation analysis; prospective studies.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart. From the original cohort of 1,044 patients with primary ICH that occurred within 48 h, 673 patients were finally included in analysis.
Figure 2
Figure 2
Mediation analysis of associations between cortical superficial siderosis and the 90-day modified Rankin scale, mediated by hematoma volume. A continuous arrow and the indirect effect by dotted arrows represent the direct effect. Adjusted potential confounders (age, sex, previous ICH, intraventricular extension, and GCS score) were selected from the multiple regression model.
See this image and copyright information in PMC

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