Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset

Andrea Morotti; Gregoire Boulouis; Andreas Charidimou; Qi Li; Loris Poli; Paolo Costa; Valeria De Giuli; Eleonora Leuci; Federico Mazzacane; Giorgio Busto; Francesco Arba; Laura Brancaleoni; Sebastiano Giacomozzi; Luigi Simonetti; Michele Laudisi; Giuseppe Micieli; Anna Cavallini; Elisa Candeloro; Massimo Gamba; Mauro Magoni; Andrew D Warren; Christopher D Anderson; M Edip Gurol; Alessandro Biffi; Anand Viswanathan; Ilaria Casetta; Enrico Fainardi; Andrea Zini; Alessandro Pezzini; Alessandro Padovani; Steven M Greenberg; Jonathan Rosand; Joshua N Goldstein

doi:10.1212/WNL.0000000000011895

Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset

Andrea Morotti, Gregoire Boulouis, Andreas Charidimou, Qi Li, Loris Poli, Paolo Costa, Valeria De Giuli, Eleonora Leuci, Federico Mazzacane, Giorgio Busto, Francesco Arba, Laura Brancaleoni, Sebastiano Giacomozzi, Luigi Simonetti, Michele Laudisi, Giuseppe Micieli, Anna Cavallini, Elisa Candeloro, Massimo Gamba, Mauro MagoniAndrew D Warren, Christopher D Anderson, M Edip Gurol, Alessandro Biffi, Anand Viswanathan, Ilaria Casetta, Enrico Fainardi, Andrea Zini, Alessandro Pezzini, Alessandro Padovani, Steven M Greenberg, Jonathan Rosand, Joshua N Goldstein

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	e2363-e237
Journal	Neurology
Volume	96
Issue number	19
DOIs	https://doi.org/10.1212/WNL.0000000000011895
Publication status	Published - Apr 1 2021

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Morotti, A., Boulouis, G., Charidimou, A., Li, Q., Poli, L., Costa, P., De Giuli, V., Leuci, E., Mazzacane, F., Busto, G., Arba, F., Brancaleoni, L., Giacomozzi, S., Simonetti, L., Laudisi, M., Micieli, G., Cavallini, A., Candeloro, E., Gamba, M., ... Goldstein, J. N. (2021). Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset. Neurology, 96(19), e2363-e237. https://doi.org/10.1212/WNL.0000000000011895

Morotti, A, Boulouis, G, Charidimou, A, Li, Q, Poli, L, Costa, P, De Giuli, V, Leuci, E, Mazzacane, F, Busto, G, Arba, F, Brancaleoni, L, Giacomozzi, S, Simonetti, L, Laudisi, M, Micieli, G, Cavallini, A, Candeloro, E, Gamba, M, Magoni, M, Warren, AD, Anderson, CD, Gurol, ME, Biffi, A, Viswanathan, A, Casetta, I, Fainardi, E, Zini, A, Pezzini, A, Padovani, A, Greenberg, SM, Rosand, J & Goldstein, JN 2021, 'Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset', Neurology, vol. 96, no. 19, pp. e2363-e237. https://doi.org/10.1212/WNL.0000000000011895

@article{86d6cd3be79540fd9bb4e17eeee8b951,

title = "Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset",

abstract = "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.",

author = "Andrea Morotti and Gregoire Boulouis and Andreas Charidimou and Qi Li and Loris Poli and Paolo Costa and {De Giuli}, Valeria and Eleonora Leuci and Federico Mazzacane and Giorgio Busto and Francesco Arba and Laura Brancaleoni and Sebastiano Giacomozzi and Luigi Simonetti and Michele Laudisi and Giuseppe Micieli and Anna Cavallini and Elisa Candeloro and Massimo Gamba and Mauro Magoni and Warren, {Andrew D} and Anderson, {Christopher D} and Gurol, {M Edip} and Alessandro Biffi and Anand Viswanathan and Ilaria Casetta and Enrico Fainardi and Andrea Zini and Alessandro Pezzini and Alessandro Padovani and Greenberg, {Steven M} and Jonathan Rosand and Goldstein, {Joshua N}",

note = "{\textcopyright} 2021 American Academy of Neurology.",

year = "2021",

month = apr,

day = "1",

doi = "10.1212/WNL.0000000000011895",

language = "English",

volume = "96",

pages = " e2363--e237",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins",

number = "19",

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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

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 -

Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset

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