26 Nov 20. Featured Paper

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

Link to paper on International Journal of Stroke.

Authors

James JM Loan, Angus B Gane, Laura Middleton, Brendan Sargent, Tom James Moullaali, Mark A Rodrigues, Laura Cunningham, Joanna Wardlaw, Rustam Al-Shahi Salman, Neshika Samarasekera, Western General Hospital, Edinburgh, Royal Infirmary of Edinburgh, St John’s Hospital, West Lothian, Astley Ainslie & Liberton Hospitals, Edinburgh

Abstract

Background: Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage & peri-hematomal edema volume.

Aims: In a community-based study, we aimed to investigate the existence, strength, direction, & independence of associations between intracerebral hemorrhage & peri-hematomal edema volumes on diagnostic brain CT & one-year functional outcome & long-term survival.

Methods: We identified all adults, resident in Lothian, diagnosed with first-ever, symptomatic spontaneous intracerebral hemorrhage between June 2010 & May 2013 in a community-based, prospective inception cohort study.

We defined regions of interest manually & used a semi-automated approach to measure intracerebral hemorrhage volume, peri-hematomal edema volume, & 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.

Results: 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 & intracerebral hemorrhage volumes were colinear (R² = 0.77).

In models using both intracerebral hemorrhage & peri-hematomal edema, 10 mL increments in intracerebral hemorrhage (adjusted odds ratio (aOR) 1.72 (95% CI 1.08–2.87); p = 0.029) but not peri-hematomal edema volume (aOR 0.92 (0.63–1.45); p = 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); p = 0.0004).

Conclusion: Total volume of intracerebral hemorrhage & peri-hematomal edema, & 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.

Keywords

• Cohort study

• Intracerebral haemorrhage

• Outcome

• Peri-hematomal edema

• Radiology

• Survival