Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Weill Cornell Medical Center, New York, NY, USA.
Neurocrit Care. 2019 Aug;31(1):40-45. doi: 10.1007/s12028-018-00668-2.
BACKGROUND: Hematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with worse outcome. Lobar ICHs are known to have better outcomes compared to deep ICH; however, it is unclear whether there are HE differences between these locations. We sought to investigate the hypothesis that lobar ICH has less HE compared to deep ICH. METHODS: Primary ICH patients admitted between 2009 and 2016 were included in a prospective single-center ICH cohort study. Patients with preceding anticoagulant use, coagulopathy on admission labs, or presenting after 24 h from symptom onset were excluded. Lobar and deep ICH patients with baseline and follow-up computed tomography (CT) (within 24 h of admission CT) were evaluated. HE was defined primarily as relative growth > 33% given expected baseline hematoma volume differences between locations. Other commonly utilized definitions of HE: > 6 mL, and > 33% or > 6 mL, were additionally assessed. Multivariable logistic regression was used to assess the association of ICH location with HE while adjusting for previously identified covariates of HE. RESULTS: There were 59 lobar and 143 deep ICH patients analyzed. Lobar ICH patients had significantly larger baseline hematoma volumes, lower admission systolic blood pressure, and longer times to admission CT compared to deep ICH. Multivariable logistic regression revealed an association of lobar ICH with lower odds of HE (> 33%) [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.11-0.93; p = 0.04] compared to deep ICH after adjusting for baseline ICH volume, blood pressure, and time to CT. Secondary analysis did not identify an association of lobar ICH with HE defined as > 6 mL (adjusted OR 1.44; 95% CI 0.59-3.50; p = 0.41) or > 33% or > 6 mL (adjusted OR 0.71; 95% CI 0.29-1.70; p = 0.44). CONCLUSION: We identified less HE in lobar compared to deep ICH. The use of absolute growth thresholds in defining HE may be limited when assessing groups with largely different baseline hematoma sizes. Further study is required to replicate our findings and investigate mechanisms for HE differences between lobar and deep ICH locations.
背景：脑出血（ICH）后的血肿扩大（HE）与预后较差相关。与深部 ICH 相比，脑叶 ICH 的预后较好；然而，目前尚不清楚这些部位之间是否存在 HE 差异。我们旨在研究以下假设，即与深部 ICH 相比，脑叶 ICH 的 HE 较少。
方法：纳入 2009 年至 2016 年期间入组的一项前瞻性单中心 ICH 队列研究的原发性 ICH 患者。排除先前使用抗凝药物、入院实验室检查存在凝血障碍或症状发作后 24 小时内入组的患者。对基线和随访 CT（入院 CT 后 24 小时内）有脑叶和深部 ICH 的患者进行评估。HE 主要定义为在位置之间预期的基线血肿体积差异下，相对增长＞33%。另外还评估了 HE 的其他常用定义：＞6ml 和＞33%或＞6ml。多变量逻辑回归用于评估 ICH 位置与 HE 之间的关系，同时调整 HE 的先前确定的协变量。
结果：共分析了 59 例脑叶 ICH 和 143 例深部 ICH 患者。与深部 ICH 相比，脑叶 ICH 患者的基线血肿体积更大，入院时收缩压更低，且从症状发作到入院 CT 的时间更长。多变量逻辑回归显示，在校正基线 ICH 体积、血压和 CT 时间后，脑叶 ICH 与 HE（＞33%）的可能性降低相关（比值比[OR]0.32；95%置信区间[CI]0.11-0.93；p=0.04）。二次分析并未发现脑叶 ICH 与 HE 定义为＞6ml（调整后的 OR 1.44；95%CI 0.59-3.50；p=0.41）或＞33%或＞6ml（调整后的 OR 0.71；95%CI 0.29-1.70；p=0.44）之间存在关联。
结论：与深部 ICH 相比，我们在脑叶 ICH 中发现了更少的 HE。在评估基线血肿体积差异较大的患者组时，使用绝对增长阈值来定义 HE 可能存在局限性。需要进一步研究来复制我们的发现，并探讨脑叶和深部 ICH 部位之间 HE 差异的机制。
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