title: Perihematomal Edema Expansion Rates and Patient Outcomes in Deep and Lobar Intracerebral Hemorrhage.
abstract: Perihematomal edema (PHE) expansion rate may predict functional outcome following spontaneous intracerebral hemorrhage (ICH). We hypothesized that the effect of PHE expansion rate on outcome is greater for deep versus lobar ICH.
  
  
  
  Subjects (n = 115) were retrospectively identified from a prospective ICH cohort enrolled from 2000 to 2013. Inclusion criteria were age ≥ 18 years, spontaneous supratentorial ICH, and known onset time. Exclusion criteria were primary intraventricular hemorrhage (IVH), trauma, subsequent surgery, or warfarin-related ICH. ICH and PHE volumes were measured from CT scans and used to calculate expansion rates. Logistic regression assessed the association between PHE expansion rates and 90-day mortality or poor functional outcome (modified Rankin Scale > 2). Odds ratios are per 0.04 mL/h.
  
  
  
  PHE expansion rate from baseline to 24 h (PHE24) was associated with mortality for deep (p = 0.03, OR 1.13[1.02-1.26]) and lobar ICH (p = 0.02, OR 1.03[1.00-1.06]) in unadjusted regression and in models adjusted for age (deep p = 0.02, OR 1.15[1.02-1.28]; lobar p = 0.03, OR 1.03[1.00-1.06]), Glasgow Coma Scale (deep p = 0.03, OR 1.13[1.01-1.27]; lobar p = 0.02, OR 1.03[1.01-1.06]), or time to baseline CT (deep p = 0.046, OR 1.12[1.00-1.25]; lobar p = 0.047, OR 1.03[1.00-1.06]). PHE expansion rate from baseline to 72 h (PHE72) was associated with mRS > 2 for deep ICH in models that were unadjusted (p = 0.02, OR 4.04[1.25-13.04]) or adjusted for ICH volume (p = 0.02, OR 4.3[1.25-14.98]), age (p = 0.03, OR 5.4[1.21-24.11]), GCS (p = 0.02, OR 4.19[1.2-14.55]), or time to first CT (p = 0.03, OR 4.02[1.19-13.56]).
  
  
  
  PHE72 was associated with poor functional outcomes after deep ICH, whereas PHE24 was associated with mortality for deep and lobar ICH.
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA. zachary.grunwald@yale.edu.
authors.forename: Zachary
authors.identifier: 0000-0002-3255-7423
authors.initials: Z
authors.lastname: Grunwald
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Urday
authors.affiliation: Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.affiliation: Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Ayres
authors.affiliation: Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.affiliation: Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Leasure
authors.affiliation: Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: Fu-Dong
authors.initials: FD
authors.lastname: Shi
authors.affiliation: Departments of Neurosurgery, Pediatrics, and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kahle
authors.affiliation: Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas W K
authors.initials: TW
authors.lastname: Battey
authors.affiliation: Departments of Neurosurgery, Pathology and Physiology, University of Maryland School of Medicine, Baltimore, MA, USA.
authors.forename: J Marc
authors.initials: JM
authors.lastname: Simard
authors.affiliation: Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: W Taylor
authors.initials: WT
authors.lastname: Kimberly
authors.affiliation: Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
keywords: Biomarker; Cerebral edema; Computed tomography; Function; Intracerebral hemorrhage; Mortality