Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage.
OBJECTIVE
We conducted this study to determine, through use of multivariate analyses, the independent predictors of hematoma enlargement occurring after hospital admission in patients with spontaneous intracerebral hemorrhage (i.c.h.).


METHODS
We reviewed 627 patients with ICH admitted within 24 hours of onset. The first CT was performed at admission and the second within 24 hours of admission, and a blood sample was taken for laboratory examinations. Univariate and multivariate analyses were performed to assess the relationships between hematoma enlargement and time from onset, consciousness level, CT findings, amount of alcohol consumption, systolic blood pressure at and after admission, clinical outcome, and hematologic parameters.


RESULTS
Eighty-eight patients (14.0%) showed enlarged hematomas after admission. Multivariate analyses revealed that the following five factors were independently associated with hematoma enlargement: the time from onset (odds ratio [OR], 0.26 for a 1-SD change; 4.9 hours; P < 0.001); the amount of alcohol consumption (OR, 1.50 for 1 SD; 46.3 g/d; P = 0.002); the sharp of hematoma (OR, 1.40 for 1 SD; 0.45 round; P = 0.006); the presence of consciousness disturbance (OR, 1.38 for 1 SD; 0.50 coma; P = 0.026); and the level of fibrinogen (OR, 0.74 for 1 SD; 87.1 mg/dL; P = 0.042). Hematoma enlargement was an independent factor increasing the mortality rate in the ICH patients (OR, 1.57; P < 0.001).


CONCLUSIONS
A particularly high likelihood of hematoma enlargement was observed in patients who (in order of importance) were admitted shortly after onset, who were heavy drinkers; who had an irregularly shaped hematoma, whose consciousness was disturbed, and who had a low level of fibrinogen.
Fujii
Y
Y
Department of Neurosurgery, Niigata University, Japan. yfujii@bri.niigata-u.ac.jp
Takeuchi
S
S
Sasaki
O
O
Minakawa
T
T
Tanaka
R
R
D000368:Aged; D000428:Alcohol Drinking; D000990:Antithrombin III / Q000378:metabolism; D001794:Blood Pressure; D002543:Cerebral Hemorrhage / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality*; D003243:Consciousness; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006406:Hematoma / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011699:Putamen / Q000098:blood supply; D012307:Risk Factors; D013599:Systole; D013788:Thalamus / Q000098:blood supply; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000979:alpha-2-Antiplasmin / Q000378:metabolism
D000979:alpha-2-Antiplasmin; D000990:Antithrombin III; D005340:Fibrinogen