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Multicenter Study
. 2024 Sep;9(3):623-629.
doi: 10.1177/23969873241247436. Epub 2024 Apr 16.

Predictors of severe intracerebral hemorrhage expansion

Andrea Morotti  1   2 , Qi Li  3 , Jawed Nawabi  4 , Giorgio Busto  5 , Federico Mazzacane  6 , Anna Cavallini  6 , Ashkan Shoamanesh  7 , Mauro Morassi  8 , Frieder Schlunk  9 , Laura Piccolo  10 , Giacomo Urbinati  11 , Debora Pezzini  1 , Maurizio Paciaroni  12 , Enrico Fainardi  5 , Ilaria Casetta  13 , Alessandro Padovani  1   2 , Andrea Zini  10
Affiliations
Multicenter Study

Predictors of severe intracerebral hemorrhage expansion

Andrea Morotti et al. Eur Stroke J. 2024 Sep.

Abstract

Background: Severe hematoma expansion (sHE) has the strongest impact on intracerebral hemorrhage (ICH) outcome. We investigated the predictors of sHE.

Methods: Retrospective analysis of ICH patients admitted at nine sites in Italy, Germany, China, and Canada. The following imaging features were analyzed: non-contrast CT (NCCT) hypodensities, heterogeneous density, blend sign, irregular shape, and CT angiography (CTA) spot sign. The outcome of interest was sHE, defined as volume increase >66% and/or >12.5 from baseline to follow-up NCCT. Predictors of sHE were explored with logistic regression.

Results: A total of 1472 patients were included (median age 73, 56.6% males) of whom 223 (15.2%) had sHE. Age (odds ratio (OR) per year, 95% confidence interval (CI), 1.02 (1.01-1.04)), Anticoagulant treatment (OR 3.00, 95% CI 2.09-4.31), Glasgow Coma Scale (OR 0.93, 95% CI 0.89-0.98), time from onset/last known well to imaging, (OR per h 0.96, 95% CI 0.93-0.99), and baseline ICH volume, (OR per mL 1.02, 95% CI 1.02-1.03) were independently associated with sHE. Ultra-early hematoma growth (baseline volume/baseline imaging time) was also a predictor of sHE (OR per mL/h 1.01, 95% CI 1.00-1.02). All NCCT and CTA imaging markers were also predictors of sHE. Amongst imaging features NCCT hypodensities had the highest sensitivity (0.79) whereas the CTA spot sign had the highest positive predictive value (0.51).

Conclusions: sHE is common in the natural history of ICH and can be predicted with few clinical and imaging variables. These findings might inform clinical practice and future trials targeting active bleeding in ICH.

Keywords: Intracerebral hemorrhage; hematoma expansion; hypodensities; spot sign; stroke.

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Conflict of interest statement

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Morotti has received expert meeting and advisory board honoraria from EMG-REG International and AstraZeneca. Dr. Shoamanesh has received speaker and consultation fees from AstraZeneca, Takeda Pharmaceuticals; and research funding from Alexion and Octapharma Canada. Dr. Paciaroni has received honoraria as a member of the speaker bureau of Sanofi-Aventis, BMS, Daiichi Sankyo, Pfizer, and iRhythm. Dr. Zini has received speaker and consultation fees from Alexion, CLS-Behring, Boehringer-Ingelheim. All the other authors report no disclosures.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Severe hematoma expansion. Baseline volume 38 mL (a), follow-up volume 119 mL (b).
Figure 2.
Figure 2.
Selection flowchart. GCS: Glasgow Coma Scale; NCCT: non-contrast computed tomography; IVH: intraventricular hemorrhage; IQR: interquartile range; LKW: last known well; ICH: intracerebral hemorrhage.
See this image and copyright information in PMC

References

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