New and expanding ventricular hemorrhage predicts poor outcome in acute intracerebral hemorrhage.
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
27 08 2019
27 08 2019
Historique:
received:
18
12
2018
accepted:
04
04
2019
pubmed:
3
8
2019
medline:
6
2
2020
entrez:
3
8
2019
Statut:
ppublish
Résumé
To describe the relationship between intraventricular hemorrhage (IVH) expansion and long-term outcome and to use this relationship to select and validate clinically relevant thresholds of IVH expansion in 2 separate intracerebral hemorrhage (ICH) populations. We used fractional polynomial analysis to test linear and nonlinear models of 24-hour IVH volume change and clinical outcome with data from the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT)-ICH study. The primary outcome was poor clinical outcome (modified Rankin Scale [mRS] score 4-6) at 90 days. We derived dichotomous thresholds from the selected model and calculated diagnostic accuracy measures. We validated all thresholds in an independent single-center ICH cohort (Massachusetts General Hospital). Of the 256 patients from PREDICT, 127 (49.6%) had an mRS score of 4 to 6. Twenty-four-hour IVH volume change and poor outcome fit a nonlinear relationship, in which minimal increases in IVH were associated with a high probability of an mRS score of 4 to 6. IVH expansion ≥1 mL (n = 53, sensitivity 33%, specificity 92%, adjusted odds ratio [aOR] 2.68, 95% confidence interval [CI] 1.11-6.46) and development of any new IVH (n = 74, sensitivity 43%, specificity 85%, aOR 2.53, 95% CI 1.22-5.26) strongly predicted poor outcome at 90 days. The dichotomous thresholds reproduced well in a validation cohort of 169 patients. IVH expansion as small as 1 mL or any new IVH is strongly predictive of poor outcome. These findings may assist clinicians with bedside prognostication and could be incorporated into definitions of hematoma expansion to inform future ICH treatment trials.
Identifiants
pubmed: 31371565
pii: WNL.0000000000008007
doi: 10.1212/WNL.0000000000008007
pmc: PMC6745728
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e879-e888Subventions
Organisme : NINDS NIH HHS
ID : K23 NS086873
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS103924
Pays : United States
Informations de copyright
© 2019 American Academy of Neurology.
Références
Neurology. 2015 Mar 10;84(10):989-94
pubmed: 25663233
Neurology. 2013 Apr 2;80(14):1295-9
pubmed: 23516315
N Engl J Med. 2013 Jun 20;368(25):2355-65
pubmed: 23713578
Lancet. 2017 Feb 11;389(10069):603-611
pubmed: 28081952
Stroke. 2012 Jul;43(7):1961-3
pubmed: 22588267
N Engl J Med. 2008 May 15;358(20):2127-37
pubmed: 18480205
N Engl J Med. 2005 Feb 24;352(8):777-85
pubmed: 15728810
Stroke. 2012 Jun;43(6):1666-8
pubmed: 22474059
Neurosurgery. 2012 May;70(5):1258-63; discussion 1263-4
pubmed: 22067423
Lancet Neurol. 2008 May;7(5):391-9
pubmed: 18396107
Stroke. 2011 Feb;42(2):465-70
pubmed: 21164132
Crit Care Med. 1999 Mar;27(3):617-21
pubmed: 10199544
Lancet Neurol. 2012 Jan;11(1):101-18
pubmed: 22172625
Lancet Neurol. 2012 Apr;11(4):307-14
pubmed: 22405630
Int J Stroke. 2014 Jun;9(4):519-24
pubmed: 23981692
Int J Stroke. 2011 Aug;6(4):302-5
pubmed: 21609412
Neurosurgery. 2006 Oct;59(4):767-73; discussion 773-4
pubmed: 17038942
Stroke. 2003 Jan;34(1):134-7
pubmed: 12511764
Stroke. 2018 Sep;49(9):2067-2073
pubmed: 30354976
Stroke. 2015 Oct;46(10):2902-8
pubmed: 26265129
PLoS One. 2018 Oct 9;13(10):e0205436
pubmed: 30300383
Stroke. 2009 Apr;40(4):1533-8
pubmed: 19246695
Int J Epidemiol. 1999 Oct;28(5):964-74
pubmed: 10597998
N Engl J Med. 2016 Sep 15;375(11):1033-43
pubmed: 27276234
Stroke Vasc Neurol. 2016 Feb 16;1(1):23-27
pubmed: 28959460
Lancet. 2018 May 26;391(10135):2107-2115
pubmed: 29778325
Neurology. 2011 Apr 5;76(14):1238-44
pubmed: 21346218