Association of baseline hematoma and edema volumes with one-year outcome and long-term survival after spontaneous intracerebral hemorrhage: A community-based inception cohort study.


Loan, James Jm ORCID: 0000-0002-6451-9448, Gane, Angus B, Middleton, Laura, Sargent, Brendan ORCID: 0000-0003-2262-7755, Moullaali, Tom James ORCID: 0000-0002-6786-3623, Rodrigues, Mark A ORCID: 0000-0002-4507-6872, Cunningham, Laura, Wardlaw, Joanna ORCID: 0000-0002-9812-6642, Al-Shahi Salman, Rustam ORCID: 0000-0002-2108-9222, Samarasekera, Neshika ORCID: 0000-0001-6840-0199 et al (show 4 more authors) (2021) Association of baseline hematoma and edema volumes with one-year outcome and long-term survival after spontaneous intracerebral hemorrhage: A community-based inception cohort study. International journal of stroke : official journal of the International Stroke Society, 16 (7). pp. 828-839.

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Abstract

<h4>Background</h4>Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume.<h4>Aims</h4>In a community-based study, we aimed to investigate the existence, strength, direction, and independence of associations between intracerebral hemorrhage and peri-hematomal edema volumes on diagnostic brain CT and one-year functional outcome and long-term survival.<h4>Methods</h4>We identified all adults, resident in Lothian, diagnosed with first-ever, symptomatic spontaneous intracerebral hemorrhage between June 2010 and May 2013 in a community-based, prospective inception cohort study. We defined regions of interest manually and used a semi-automated approach to measure intracerebral hemorrhage volume, peri-hematomal edema volume, and the sum of these measurements (total lesion volume) on first diagnostic brain CT performed at ≤3 days after symptom onset. The primary outcome was death or dependence (scores 3-6 on the modified Rankin Scale) at one-year after intracerebral hemorrhage.<h4>Results</h4>Two hundred ninety-two (85%) of 342 patients (median age 77.5 y, IQR 68-83, 186 (54%) female, median time from onset to CT 6.5 h (IQR 2.9-21.7)) were dead or dependent one year after intracerebral hemorrhage. Peri-hematomal edema and intracerebral hemorrhage volumes were colinear (<i>R</i><sup>2</sup> = 0.77). In models using both intracerebral hemorrhage and peri-hematomal edema, 10 mL increments in intracerebral hemorrhage (adjusted odds ratio (aOR) 1.72 (95% CI 1.08-2.87); <i>p</i> = 0.029) but not peri-hematomal edema volume (aOR 0.92 (0.63-1.45); <i>p</i> = 0.69) were independently associated with one-year death or dependence. 10 mL increments in total lesion volume were independently associated with one-year death or dependence (aOR 1.24 (1.11-1.42); <i>p</i> = 0.0004).<h4>Conclusion</h4>Total volume of intracerebral hemorrhage and peri-hematomal edema, and intracerebral hemorrhage volume alone on diagnostic brain CT, undertaken at three days or sooner, are independently associated with death or dependence one-year after intracerebral hemorrhage, but peri-hematomal edema volume is not.<h4>Data access statement</h4>Anonymized summary data may be requested from the corresponding author.

Item Type: Article
Uncontrolled Keywords: Western General Hospital, Edinburgh, Royal Infirmary of Edinburgh, St John’s Hospital, West Lothian, Astley Ainslie and Liberton Hospitals, Edinburgh, Humans, Brain Edema, Cerebral Hemorrhage, Hematoma, Cohort Studies, Prospective Studies, Adult, Aged, Female, Male, Stroke
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Clinical Directorate
Depositing User: Symplectic Admin
Date Deposited: 04 Aug 2022 15:28
Last Modified: 16 Mar 2024 06:59
DOI: 10.1177/1747493020974282
Open Access URL: https://journals.sagepub.com/doi/pdf/10.1177/17474...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3160359
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