title: Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage.
abstract: BACKGROUND
  Perihaematomal edema (PHE) expansion rate may be a predictor of outcome after intracerebral haemorrhage (ICH). We determined whether PHE expansion rate in the first 72 hours after ICH predicts outcome, and how it compares against other PHE measures.
  
  
  METHODS
  We included patients from the Virtual International Stroke Trials Archive. We calculated PHE expansion rate using the equation: (PHE at 72 hours PHE at baseline)/(time to 72-hour CT scan time to baseline CT scan). Outcomes of interest were mortality and poor 90-day outcome (modified Rankin Scale score of ≥3). Logistic regression was used to assess relationships with outcome.
  
  
  RESULTS
  A total of 596 patients with ICH were included. At baseline, median haematoma volume was 15.0 mL (IQR 7.9-29.2) with median PHE volume of 8.7 mL (IQR 4.5-15.5). Median PHE expansion rate was 0.31 mL/hour (IQR 0.12-0.55). The odds of mortality were greater with increasing PHE expansion rate (OR 2.63, CI 1.10 to 6.25), while the odds of poor outcome also increased with greater PHE growth (OR 1.67, CI 1.28 to 2.39). Female sex had an inverse relationship with PHE growth, but baseline haematoma volume had a direct correlation. Among other PHE measures, only interval increase in PHE correlated with poor outcome. There was no significant difference between the 2 measures of PHE volume expansion.
  
  
  CONCLUSIONS
  Rate of PHE growth over 72 hours was an independent predictor of mortality and poor functional outcomes following ICH. Baseline haematoma volume and gender appear to influence PHE growth.
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, New York, USA Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Santosh B
authors.initials: SB
authors.lastname: Murthy
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Urday
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.affiliation: Department of Cerebrovascular Medicine, University of Glasgow, Glasgow, UK.
authors.forename: Jesse
authors.initials: J
authors.lastname: Dawson
authors.affiliation: Department of Cerebrovascular Medicine, University of Glasgow, Glasgow, UK.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Lees
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Center for Human Genetic Research Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: W Taylor
authors.initials: WT
authors.lastname: Kimberly
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, New York, USA Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Costantino
authors.initials: C
authors.lastname: Iadecola
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, New York, USA Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hanley
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
authors.affiliation: Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Ziai
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000401:mortality*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012372:ROC Curve; D014057:Tomography, X-Ray Computed