作者
Andrea Morotti,Grégoire Boulouis,Jawed Nawabi,Qi Li,Andreas Charidimou,Marco Pasi,Frieder Schlunk,Ashkan Shoamanesh,Aristeidis H. Katsanos,Federico Mazzacane,Giorgio Busto,Francesco Arba,Laura Brancaleoni,Sebastiano Giacomozzi,L. Simonetti,Andrew Warren,Michele Laudisi,Anna Cavallini,M. Edip Gurol,Anand Viswanathan,Andrea Zini,Ilaria Casetta,Enrico Fainardi,Steven M. Greenberg,Alessandro Padovani,Jonathan Rosand,Joshua N. Goldstein
摘要
Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE.This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (<0%), mild (0%-33%), moderate (33.1%-66%), and severe (>66%). Absolute HE (aHE) was classified as none (<0 mL), mild (0-6.0 mL), moderate (6.1-12.5 mL), and severe (>12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4-6) were explored with logistic regression.We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%, p < 0.001 and 18.3% vs 7.2%, p < 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38-2.82, p < 0.001; aHE OR 1.73, 95% CI 1.23-2.45, p = 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL.The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies.