A practical prediction model for early hematoma expansion in spontaneous deep ganglionic intracerebral hemorrhage

Ririko Takeda, Takeshi Ogura, Hidetoshi Ooigawa, Goji Fushihara, Shin-Ichiro Yoshikawa, Daisuke Okada, Ryuichiro Araki, Hiroki Kurita
Clinical Neurology and Neurosurgery 2013, 115 (7): 1028-31

OBJECTIVE: Early hematoma expansion is a known cause of morbidity and mortality in patients with intracerebral hemorrhage (ICH). The goal of this study was to identify clinical predictors of ICH growth in the acute stage.

MATERIALS AND METHODS: We studied 201 patients with acute (<6h) deep ganglionic ICH. Patients underwent CT scan at baseline and hematoma expansion (>33% or >12.5ml increase) was determined on the second scan performed within 24h. Fourteen clinical and neuroimaging variables (age, gender, GCS at admission, hypertension, diabetes mellitus, kidney disease, stroke, hemorrhagic, antiplatelet use, anticoagulant use, hematoma density heterogeneity, hematoma shape irregularity, hematoma volume and presence of IVH) were registered. Additionally, blood pressure was registered at initial systolic BP (i-SBP) and systolic BP 1.5h after admission (1.5h-SBP). The discriminant value of the hematoma volume and 1.5h-SBP for hematoma expansion were determined by the receiver operating characteristic (ROC) curves. Factors associated with hematoma expansion were analyzed with multiple logistic regression.

RESULTS: Early hematoma expansion occurred in 15 patients (7.0%). The cut-off value of hematoma volume and 1.5h-SBP were determined to be 16ml and 160mmHg, respectively. Hematoma volume above 16ml (HV>16) ([OR]=5.05, 95% CI 1.32-21.36, p=0.018), hematoma heterogeneity (HH) ([OR]=7.81, 95% CI 1.91-40.23, p=0.004) and 1.5h-SBP above 160mmHg (1.5h-SBP>160) ([OR]=8.77, 95% CI 2.33-44.56, p=0.001) independently predicted ICH expansion. If those three factors were present, the probability was estimated to be 59%.

CONCLUSIONS: The presented model (HV>16, HH, 1.5h-SBP>160) can be a practical tool for prediction of ICH growth in the acute stage. Further prospective studies are warranted to validate the ability of this model to predict clinical outcome.


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