title: Significance of intraventricular hemorrhage in acute intracerebral hemorrhage: intensive blood pressure reduction in acute cerebral hemorrhage trial results.
abstract: OBJECTIVE
  Intraventricular hemorrhage (IVH) with spontaneous intracerebral hemorrhage indicates a poor prognosis but uncertainty exists over the pattern of association. We aimed to elucidate risk associations of IVH and outcome in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) data set.
  
  
  METHODS
  INTERACT2 was an international prospective, open-blinded end point, randomized controlled trial in 2839 patients with intracerebral hemorrhage (<6 hours) with elevated systolic blood pressure randomly assigned to intensive (target systolic blood pressure <140 mm Hg) or guideline-based (systolic blood pressure <180 mm Hg) blood pressure management. Associations of baseline IVH in 740 of 2613 (28%) patients and poor outcomes (death and major disability defined on the modified Rankin Scale) at 90 days were determined in linear and logistic regression models.
  
  
  RESULTS
  Patients with IVH were significantly older and with greater neurological impairment, history of ischemic stroke, and larger hematomas more often deep hemisphere located at presentation, after adjustment for other baseline variables. Death or major disability occurred in 66% with IVH versus 49% in intracerebral hemorrhage-alone patients (adjusted odds ratio, 1.68; 95% confidence interval, 1.38-2.06; P<0.01). Associations of IVH volume and clinical outcomes were strong and near continuous. Adjusted analyses by thirds of IVH volume indicate thresholds of ≈5 and 10 mL for significantly increased odds of death and death or major disability, respectively.
  
  
  CONCLUSIONS
  A strong association exists between the amount of IVH and poor outcome in intracerebral hemorrhage. An IVH volume of 5 to 10 mL emerges as a significant threshold for decision making on prognosis in these patients.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Edward
authors: E
authors: Chan
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.). canderson@george.org.au.
authors: Craig S
authors: CS
authors: Anderson
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Xia
authors: X
authors: Wang
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Hisatomi
authors: H
authors: Arima
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Anubhav
authors: A
authors: Saxena
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Tom J
authors: TJ
authors: Moullaali
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Emma
authors: E
authors: Heeley
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Candice
authors: C
authors: Delcourt
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Guojun
authors: G
authors: Wu
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Jinchao
authors: J
authors: Wang
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Guofang
authors: G
authors: Chen
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Pablo M
authors: PM
authors: Lavados
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Christian
authors: C
authors: Stapf
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Thompson
authors: T
authors: Robinson
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: John
authors: J
authors: Chalmers
authors: From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
authors: Yining
authors: Y
authors: Huang
mesh_terms: D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure; D001932:Brain Neoplasms / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000473:pathology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D013599:Systole; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: cerebral hemorrhage; cerebral ventricles; clinical trial; mortality; outcome measures