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Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage

BACKGROUND: Although volume of intracerebral hemorrhage (ICH) is a predictor of mortality, it is unknown whether subsequent hematoma growth further increases the risk of death or poor functional outcome. - METHODS: To determine if hematoma growth independently predicts poor outcome, the authors perf...

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Main Authors: Davis, Stephen (Author) , Broderick, J. (Author) , Hennerici, Michael G. (Author) , Brun, N. C. (Author) , Diringer, M. N. (Author) , Mayer, S. A. (Author) , Begtrup, K. (Author) , Steiner, T. (Author)
Format: Article (Journal)
Language:English
Published: April 24, 2006
In: Neurology
Year: 2006, Volume: 66, Issue: 8, Pages: 1175-1181
ISSN:1526-632X
DOI:10.1212/01.wnl.0000208408.98482.99
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1212/01.wnl.0000208408.98482.99
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Author Notes:S.M. Davis, J. Broderick, M. Hennerici, N.C. Brun, M.N. Diringer, S.A. Mayer, K. Begtrup, and T. Steiner, for the Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators

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520 |a BACKGROUND: Although volume of intracerebral hemorrhage (ICH) is a predictor of mortality, it is unknown whether subsequent hematoma growth further increases the risk of death or poor functional outcome. - METHODS: To determine if hematoma growth independently predicts poor outcome, the authors performed an individual meta-analysis of patients with spontaneous ICH who had CT within 3 hours of onset and 24-hour follow-up. Placebo patients were pooled from three trials investigating dosing, safety, and efficacy of rFVIIa (n = 115), and 103 patients from the Cincinnati study (total 218). Other baseline factors included age, gender, blood glucose, blood pressure, Glasgow Coma Score (GCS), intraventricular hemorrhage (IVH), and location. - RESULTS: Overall, 72.9% of patients exhibited some degree of hematoma growth. Percentage hematoma growth (hazard ratio [HR] 1.05 per 10% increase [95% CI: 1.03, 1.08; p < 0.0001]), initial ICH volume (HR 1.01 per mL [95% CI: 1.00, 1.02; p = 0.003]), GCS (HR 0.88 [95% CI: 0.81, 0.96; p = 0.003]), and IVH (HR 2.23 [95% CI: 1.25, 3.98; p = 0.007]) were all associated with increased mortality. Percentage growth (cumulative OR 0.84 [95% CI: 0.75, 0.92; p < 0.0001]), initial ICH volume (cumulative OR 0.94 [95% CI: 0.91, 0.97; p < 0.0001]), GCS (cumulative OR 1.46 [95% CI: 1.21, 1.82; p < 0.0001]), and age (cumulative OR 0.95 [95% CI: 0.92, 0.98; p = 0.0009]) predicted outcome modified Rankin Scale. Gender, location, blood glucose, and blood pressure did not predict outcomes. - CONCLUSIONS: Hematoma growth is an independent determinant of both mortality and functional outcome after intracerebral hemorrhage. Attenuation of growth is an important therapeutic strategy. 
650 4 |a Aged 
650 4 |a Cerebral Hemorrhage 
650 4 |a Factor VII 
650 4 |a Factor VIIa 
650 4 |a Female 
650 4 |a Hematoma, Subdural 
650 4 |a Humans 
650 4 |a Male 
650 4 |a Prognosis 
650 4 |a Recombinant Proteins 
650 4 |a Risk Factors 
650 4 |a Tomography, X-Ray Computed 
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