Optimal intraventricular hemorrhage volume cutoff for predicting poor outcome in patients with intracerebral hemorrhage

Background and objectives The prognosis of patients with spontaneous intracerebral hemorrhage (ICH) is often influenced by hematoma volume, a well-established predictor of poor outcome. However, the optimal intraventricular hemorrhage (IVH) volume cutoff for predicting poor outcome remains unknown. Methods We analyzed 313 patients with spontaneous ICH not undergoing evacuation, including 7 cases with external ventricular drainage (EVD). These patients underwent a baseline CT scan, followed by a 24-hour CT scan for measurement of both hematoma and IVH volumes. We defined hematoma growth as hematoma growth >33% or 6mL at follow-up CT, and poor outcome as modified Rankin Scale score≥3 at three months. Cutoffs with optimal sensitivity and specificity for predicting poor outcome were identified using receiver operating curves. Results The receiver operating characteristic analysis identified 6 mL as the optimal cutoff for predicting poor outcome. IVH volume>6mL was observed in 53 (16.9%) of 313 patients. Patients with IVH volume>6mL were more likely to be older and had higher NIHSS score and lower GCS score than those without. IVH volume>6mL (adjusted OR 2.43, 95% CI 1.13-5.30; P=0.026) was found to be an independent predictor of poor clinical outcome at three months in multivariable regression analysis. Conclusions Optimal IVH volume cutoff represents a powerful tool for improving the prediction of poor outcome in patients with ICH, particularly in the absence of clot evacuation or common use of EVD. Small amounts of intraventricular blood are not independently associated with poor outcome in patients with intracerebral hemorrhage. The utilization of optimal IVH volume cutoffs may improve the clinical trial design by targeting ICH patients that will obtain maximal benefit from therapies.