Predicting ICH outcomes with peak perihemorrhagic edema (PHE)

Peak perihemorrhagic edema (PHE) volume is an independent predictor of functional outcome following an intracerebral hemorrhage (ICH). According to findings from a retrospective study published in Neurology inflammatory processes and hematoma expansion seem to be involved in PHE evolution and may represent important treatment targets.


Retrospective analysis
Patients in whom spontaneous supratentorial ICH developed between 2006 and 2014 were included in this retrospective analysis (n=292). Investigators assessed ICH and PHE volumes and used multivariable logistic regression and propensity score matching analyses to examine these measures and their association with functional outcome up to 90 days. A modified Rankin Scale of 0 to 3 and 4 to 6 represented favorable and poor outcomes, respectively.

The median ICH volume was 17.7 mL (interquartile range [IQR] 7.9-40.2) at time of hospital admission, whereas the median peak ICH volume was 22.5 mL (IQR 8.9-46.4). In addition, the baseline median PHE volume on admission was 16.3 mL (IQR 9.1-29.2), which increased to a median peak volume of 37.5 mL (IQR 19.0-60.6) over approximately 7 days (IQR 3-12).


Independent predictor
According to multivariable logistic regression analysis, the peak PHE volume was deemed an independent predictor for 90-day functional outcome (odds ratio [OR] 0.984 for each mL of PHE; 95% CI, 0.973-0.994). In addition, the peak PHE volume was associated with the initial PHE increase up to 3 days following admission (OR 1.060; 95% CI, 1.018-1.103) and was independently associated with the neutrophil to lymphocyte ratio on day 6 (OR 1.236; 95% CI, 1.034-1.477; propensity score matching cohort, n=124). In addition, the investigators found that there was an independent association between the initial PHE increase and fever burden on days 2 to 3 (OR 1.456; 95% CI, 1.103-1.920) as well as hematoma expansion (OR 3.647; 95% CI, 1.533-8.679).



Source: NeurologyAdvisor | March 29, 2018

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