Abstract Details

Title Predictors and Outcome of Hematoma Expansion in Patients with Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 245

Objective

Background BACKGROUND: Hematoma growth is an independent determinant of mortality and morbidity in patients with ICH. Studies attempting to identify predictors of hematoma expansion had conflicting results.

Design/Methods DESIGN/METHODS: We reviewed our prospective database of patients with spontaneous ICH between January 2009 and June 2012. Patients were divided into two groups based on the presence or absence of hematoma expansion. Hematoma volume was calculated by thin volumetric CT images using a special software. Expansion was defined as 33% increase in hematoma volume over 24 hours. We compared the baseline demographics, risk factors, laboratory parameters, medications, and CT findings between the two groups using Fisher's exact test. A multivariate regression analysis was performed to identify predictors of expansion.

Results RESULTS: We identified 200 patients with spontaneous ICH. On univariate analysis, patients with hematoma expansion were more likely to have congestive heart failure (32% vs 6%, p=<0.001), Coumadin use (37% vs 11% p=0.001), low admission GCS (9 ± 4, 11 ± 4, p=0.003), intraventricular hemorrhage (79% vs 45% p= 0.002) and hydrocephalus (43% vs 22% p=0.032). On multivariate regression analysis, congestive heart failure (OR=9.7, 95% CI: 2.5,37.7; p=0.001, prior Coumadin use (OR=3.6, 95% CI: 1.3,10.3; p=0.016) and intraventricular hemorrhage (OR=5.7, 95%CI: 1.5,20.9; p=0.009) were significant predictors of hematoma expansion. The ICU length of stay (8 ± 8 vs 4 ± 6, p=0.004), intubation rate (82% vs 32%, p=0.034), and hospital mortality (68% vs 20%, p=<0.001) was significantly higher in patients with hematoma expansion.

Conclusions CONCLUSIONS: Patients with congestive heart failure, prior Coumadin use, and intraventricular hemorrhages are at risk of hematoma expansion. Aggressive measures to monitor for and prevent hematoma growth in these patients are important. Larger studies are needed to confirm these results.

Authors/Disclosures
Archana Hinduja, MD PRESENTER	Dr. Hinduja has nothing to disclose.
Jamil R. Dibu, MD (Cleveland Clinic Abu Dhabi)	No disclosure on file
Anand V. Patel, MD (University of Texas Medical Branch)	Dr. Patel has nothing to disclose.
Eugene Y. Achi, MD (Cleveland Clinic Abu Dhabi)	No disclosure on file
	No disclosure on file
Shadi Yaghi, MD (Hackensack Meridian Health)	Dr. Yaghi has nothing to disclose.
Ludwig Kappos, MD, FAAN (RC2NB, University Hospital Basel)	Dr. Kappos has nothing to disclose.

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