From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston.
Neurology. 2023 Oct 17;101(16):e1606-e1613. doi: 10.1212/WNL.0000000000207728. Epub 2023 Aug 21.
Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE.
This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (<0%), mild (0%-33%), moderate (33.1%-66%), and severe (>66%). Absolute HE (aHE) was classified as none (<0 mL), mild (0-6.0 mL), moderate (6.1-12.5 mL), and severe (>12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4-6) were explored with logistic regression.
We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%, < 0.001 and 18.3% vs 7.2%, < 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38-2.82, < 0.001; aHE OR 1.73, 95% CI 1.23-2.45, = 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL.
The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies.
血肿扩大（HE）是导致脑出血（ICH）患者神经功能恶化和预后不良的主要决定因素，也是一个很有吸引力的治疗靶点。我们分析了不同程度 HE 的预后影响。
这是一项回顾性分析，纳入了在意大利、德国、加拿大、中国和美国 8 所学术机构就诊的 ICH 患者。所有患者均接受基线和随访影像学检查以评估 HE。相对 HE（rHE）分为无（<0%）、轻度（0%-33%）、中度（33.1%-66%）和重度（>66%）。绝对 HE（aHE）分为无（<0 毫升）、轻度（0-6.0 毫升）、中度（6.1-12.5 毫升）和重度（>12.5 毫升）。采用 logistic 回归分析探讨不良功能结局（90 天改良 Rankin 量表评分 4-6 分）的预测因素。
共纳入 2163 例患者，其中 1211 例（56.0%）预后不良。不良预后患者发生重度 aHE 或 rHE 的比例更高（13.9%比 6.5%，<0.001；18.3%比 7.2%，<0.001）。logistic 回归分析证实了这种关联（rHE 比值比 [OR] 1.98，95%CI 1.38-2.82，<0.001；aHE OR 1.73，95%CI 1.23-2.45，=0.002），而轻度或中度 HE 与不良预后之间无关联。重度 HE 与不良预后的关联仅在基线 ICH 体积<30 毫升的患者中显著。
在初始体积较小的患者中，HE 与结局之间的关联最强。这些发现可能为临床试验设计提供信息，并指导临床医生选择抗扩大治疗的患者。
