TY - JOUR
T1 - Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset
AU - Morotti, Andrea
AU - Boulouis, Gregoire
AU - Charidimou, Andreas
AU - Li, Qi
AU - Poli, Loris
AU - Costa, Paolo
AU - De Giuli, Valeria
AU - Leuci, Eleonora
AU - Mazzacane, Federico
AU - Busto, Giorgio
AU - Arba, Francesco
AU - Brancaleoni, Laura
AU - Giacomozzi, Sebastiano
AU - Simonetti, Luigi
AU - Laudisi, Michele
AU - Micieli, Giuseppe
AU - Cavallini, Anna
AU - Candeloro, Elisa
AU - Gamba, Massimo
AU - Magoni, Mauro
AU - Warren, Andrew D
AU - Anderson, Christopher D
AU - Gurol, M Edip
AU - Biffi, Alessandro
AU - Viswanathan, Anand
AU - Casetta, Ilaria
AU - Fainardi, Enrico
AU - Zini, Andrea
AU - Pezzini, Alessandro
AU - Padovani, Alessandro
AU - Greenberg, Steven M
AU - Rosand, Jonathan
AU - Goldstein, Joshua N
N1 - © 2021 American Academy of Neurology.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - OBJECTIVE: To investigatethe prevalence, predictors and prognostic impact of hematoma expansion (HE) inintracerebral hemorrhage (ICH) patients with unclear symptom onset (USO).METHODS: Retrospective analysis of patients with primary spontaneous ICH admitted at 5 academic medical centers in USA and Italy.HE (volume increase >6 mL and/or >33% from baseline to follow-up non-contrast CT [NCCT]) and mortality at 30 days were the outcomes of interest. Baseline NCCT was also analyzed for presence of hypodensities (any hypodense region within the hematoma margins). Predictors of HE and mortality were explored with multivariable logistic regression.RESULTS: We enrolled 2,165 subjects, 1,022 in the development cohort and 1,143 in the replication cohort, of whom 352 (34.4%) and 407 (35.6%) had ICH with USO respectively. When compared with subjects having a clear symptom onset, USO patients had a similar frequency of HE (25.0% vs 21.9%, p = 0.269 and 29.9% vs 31.5%, p = 0.423). Among USO patients, HE was independently associated with mortality after adjustment for confounders (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.43-4.89, p = 0.002). This finding wassimilar in the replication cohort (OR 3.46, 95% CI 1.86-6.44, p < 0.001). The presence of NCCT hypodensities in USO subjects was an independent predictor of HE in the development (OR 2.59, 95% CI 1.27-5.28, p = 0.009) and replication (OR 2.43, 95% CI 1.42-4.17, p = 0.001) population.CONCLUSION: HE is common in USO patients and independently associated with worse outcome. These findings suggest that USO patients may be enrolled in clinical trials on medical treatments targeting HE.
AB - OBJECTIVE: To investigatethe prevalence, predictors and prognostic impact of hematoma expansion (HE) inintracerebral hemorrhage (ICH) patients with unclear symptom onset (USO).METHODS: Retrospective analysis of patients with primary spontaneous ICH admitted at 5 academic medical centers in USA and Italy.HE (volume increase >6 mL and/or >33% from baseline to follow-up non-contrast CT [NCCT]) and mortality at 30 days were the outcomes of interest. Baseline NCCT was also analyzed for presence of hypodensities (any hypodense region within the hematoma margins). Predictors of HE and mortality were explored with multivariable logistic regression.RESULTS: We enrolled 2,165 subjects, 1,022 in the development cohort and 1,143 in the replication cohort, of whom 352 (34.4%) and 407 (35.6%) had ICH with USO respectively. When compared with subjects having a clear symptom onset, USO patients had a similar frequency of HE (25.0% vs 21.9%, p = 0.269 and 29.9% vs 31.5%, p = 0.423). Among USO patients, HE was independently associated with mortality after adjustment for confounders (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.43-4.89, p = 0.002). This finding wassimilar in the replication cohort (OR 3.46, 95% CI 1.86-6.44, p < 0.001). The presence of NCCT hypodensities in USO subjects was an independent predictor of HE in the development (OR 2.59, 95% CI 1.27-5.28, p = 0.009) and replication (OR 2.43, 95% CI 1.42-4.17, p = 0.001) population.CONCLUSION: HE is common in USO patients and independently associated with worse outcome. These findings suggest that USO patients may be enrolled in clinical trials on medical treatments targeting HE.
U2 - 10.1212/WNL.0000000000011895
DO - 10.1212/WNL.0000000000011895
M3 - Article
C2 - 33795389
VL - 96
SP - e2363-e237
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 19
ER -