04 Nov 20. Featured Paper

Association between computed tomographic biomarkers of cerebral small vessel diseases & long‐term outcome after spontaneous intracerebral hemorrhage.

Link to paper on Annals of Neurology

Authors

Mark A. Rodrigues FRCR, PhD, Neshika E. Samarasekera MRCP, PhD, Christine Lerpiniere RGN, Luke A. Perry MBBS, Tom J. Moullaali MBBS, MRCP, James J.M. Loan MRCS, MSc, Joanna M. Wardlaw FRCR, MD,  Rustam Al‐Shahi Salman MA PhD FRCPEdin FESO for the Lothian Audit of the Treatment of Cerebral Haemorrhage Collaborators

Abstract

Objective: A study was undertaken to assess whether cerebral small vessel disease (SVD) computed tomographic (CT) biomarkers are associated with long‐term outcome after intracerebral hemorrhage.

Methods: We performed a prospective, community‐based cohort study of adults diagnosed with spontaneous intracerebral hemorrhage between June 1, 2010 & May 31, 2013.

A neuroradiologist rated the diagnostic brain CT for acute intracerebral hemorrhage features & SVD biomarkers.

We used severity of white matter lucencies & cerebral atrophy, & the number of lacunes to calculate the CT SVD score.

We assessed the association between CT SVD biomarkers & either death, or death or dependence (modified Rankin Scale scores = 4–6) 1 year after first‐ever intracerebral hemorrhage using logistic regression, adjusting for known predictors of outcome.

Results: Within 1 year of intracerebral hemorrhage, 224 (56%) of 402 patients died.

In separate models, 1‐year death was associated with severe atrophy (adjusted odds ratio [aOR] = 2.54, 95% confidence interval [CI] = 1.44–4.49, p = 0.001) but not lacunes or severe white matter lucencies, & CT SVD sum score ≥ 1 (aOR = 2.50, 95% CI = 1.40–4.45, p = 0.002).

Two hundred seventy‐seven (73%) of 378 patients with modified Rankin Scale data were dead or dependent at 1 year.

In separate models, 1‐year death or dependence was associated with severe atrophy (aOR = 3.67, 95% CI = 1.71–7.89, p = 0.001) & severe white matter lucencies (aOR = 2.18, 95% CI = 1.06–4.51, p = 0.035) but not lacunes, & CT SVD sum score ≥ 1 (aOR = 2.81, 95% CI = 1.45–5.46, p = 0.002).

Interpretation: SVD biomarkers on the diagnostic brain CT are associated with 1‐year death & dependence after intracerebral hemorrhage, independent of known predictors of outcome. ANN NEUROL 2020

Keywords

• Biomarkers
• Computed tomography (CT)
• Intracerebral hemorrhage
• Small vessel disease (SVD)