title: Predictors of late neurological deterioration after spontaneous intracerebral hemorrhage.
abstract: BACKGROUND
  Although intracerebral hemorrhage (ICH) is a common form of cerebrovascular disease, little is known about factors leading to neurological deterioration occurring beyond 48 h after hematoma formation. The purpose of this study was to characterize the incidence, consequences, and associative factors of late neurological deterioration (LND) in patients with spontaneous ICH.
  
  
  METHODS
  Using the Duke University Hospital Neuroscience Intensive Care Unit database from July 2007 to June 2012, a cohort of 149 consecutive patients with spontaneous supratentorial ICH met criteria for analysis. LND was defined as a decrease of two or more points in Glasgow Coma Scale score or death during the period from 48 h to 1 week after ICH symptom onset. Unfavorable outcome was defined as a modified Rankin Scale score of >2 at discharge.
  
  
  RESULTS
  Forty-three subjects (28.9 %) developed LND. Logistic regression models revealed hematoma volume (OR = 1.017, 95 % CI 1.003-1.032, p = 0.019), intraventricular hemorrhage (OR = 2.519, 95 % CI 1.142-5.554, p = 0.022) and serum glucose on admission (OR = 2.614, 95 % CI 1.146-5.965, p = 0.022) as independent predictors of LND. After adjusting for ICH score, LND was independently associated with unfavorable outcome (OR = 4.000, 95 % CI 1.280-12.500, p = 0.017). In 65 subjects with follow-up computed tomography images, an increase in midline shift, as a surrogate for cerebral edema, was independently associated with LND (OR = 3.822, 95 % CI 1.157-12.622, p = 0.028).
  
  
  CONCLUSIONS
  LND is a common phenomenon in patients with ICH; further, LND appears to affect outcome. Independent predictors of LND include hematoma volume, intraventricular hemorrhage, and blood glucose on admission. Progression of perihematomal edema may be one mechanism for LND.
authors: Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors: Weiping
authors: W
authors: Sun
authors: Wenqin
authors: W
authors: Pan
authors: Peter G
authors: PG
authors: Kranz
authors: Claire E
authors: CE
authors: Hailey
authors: Rachel A
authors: RA
authors: Williamson
authors: Wei
authors: W
authors: Sun
authors: Daniel T
authors: DT
authors: Laskowitz
authors: Michael L
authors: ML
authors: James
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors
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