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- Title
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.
- Authors
Loan, James JM; Gane, Angus B; Middleton, Laura; Sargent, Brendan; Moullaali, Tom James; Rodrigues, Mark A; Cunningham, Laura; Wardlaw, Joanna; Salman, Rustam Al-Shahi; Samarasekera, Neshika; Addison, Anne; Ahmad, Kate; Alhadad, Syed; Andrews, Peter; Bisset, Elaine; Bodkin, Peter; Bouhaidar, Ralph; Brennan, Paul; Campbell, Brian; Chandran, Siddharthan
- Abstract
Background: Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume. Aims: 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. Methods: 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. 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 and intracerebral hemorrhage volumes were colinear (R 2 = 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); 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 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. Data access statement: Anonymized summary data may be requested from the corresponding author.
- Subjects
INTRACEREBRAL hematoma; CEREBRAL hemorrhage; SURVIVAL rate; HEMATOMA; EDEMA; COHORT analysis
- Publication
International Journal of Stroke, 2021, Vol 16, Issue 7, p828
- ISSN
1747-4930
- Publication type
Article
- DOI
10.1177/1747493020974282