Association of baseline hematoma and edema volumes with one-year outcome and long-term survival after spontaneous intracerebral hemorrhage: A community-based inception cohort study
Authors: Loan James JM , Gane Angus B , Middleton Laura , Sargent Brendan , Moullaali Tom James , Rodrigues Mark A , Cunningham Laura , Wardlaw Joanna , Al-Shahi Salman Rustam , Samarasekera Neshika ,   Western General Hospital, Edinburgh, Addison Anne , Ahmad Kate , Alhadad Syed , Andrews Peter , Bisset Elaine , Bodkin Peter , Bouhaidar Ralph , Brennan Paul , Campbell Brian , Chandran Siddharthan , Cook Helen , Davenport Richard , Dennis Martin , Derry Chris , Dodds Katrina , Doubal Fergus , Duncan Susan , Elder Andrew , Fitzpatrick Mike , Foley Peter , Fouyas Ioannis , Ghosh Sudipto , Gibson Rod , Gordon Claire , Grant Robin , Hewett Russell , Hughes Fiona , Hughes Mark , Hunt David , Hunter Neil , Ironside James , Liaquat Imran , Josephson Colin , Kamat Anant , Kealley Susan , Keir Sarah , Kerr Gillian , Kerrigan Simon , Keston Peter , King Matthew , Knight Richard , Macdonald Elizabeth , Mackay Graham , Macleod Donald , Macleod Malcolm , Maguire Conor , Makin Steven , Mathews Ashok , Maxwell Fiona , McClellan Stuart , Millar Tracey , Morris Zoe , Morse Tim , Mumford Colin , Murray Katherine , Myles Lynn , Nimmo Graham , Ng Yi , Pal Suvankar , Rannikmae Kristiina , Rhodes Jonathan , Ross Jerard , Russell Tim , Sandercock Peter , Sellar Robin , Shanmuganathan Mano , Shekhar Himanshu , Simms Henry , Sittampalam Mara , Smith Colin , Soleiman Hamza , Spiers Helen , Statham Patrick , Stavrinos Neo , Stone Jon , Stuart Joyce , Sudlow Cathie , Summers David , Taylor Pat , Torgersen Antonia , van Dijke Margarethe , Walker Robert , Weller Belinda , Whiteley William , Whittle Ian , Will Robert , Young Wendy ,   Royal Infirmary of Edinburgh, Anderson Judith , Broadbent Seona , Butler Laura , Caesar Dave , Cantley Patricia , Carter Jonathan , Clegg Gareth , Coull Andrew , Crosswaite Alastair , Dear James , Dummer Simon , Duncan Fiona , Elder-Gracie Trish , Enright Kate , Fitzgerald Tom , Fothergill Jane , Frier Brian , Grant David , Gray Alasdair , Hart Simon , Henderson Robin , Jaap Alan , Leigh-Smith Simon , Jones Michael , Masson Moyra , McCallum Lynn , McKechnie Martin , McKillop Graham , Mead Gillian , Morley Wendy , Morrow Billie , Morrow Frank , Murchison Jon , Murphy Ross , Ng Jasmine , Ogundipe Olayinka , Patel Dilip , Pollock Alison , Reed Matthew , Roberts Geraint , Selvarajah Johann , Smith Randy , Stirling Claire , Turner Neil , Wilson Matthew , Yordanov Stanko ,   St John’s Hospital, West Lothian, Bell Nicola , Chambers Sarah , Dewar Sandra , Farquhar Donald , Harmouche Ali , Jacob Ashok , Jackson Katherine , Knox Anne , McCafferty Jon , Moultrie Sam , Munang Latana , Noble Donald , Ramsay Scott , Spence Linda , Threlfall Bethany , Williams Andrew , Wilson James ,   Astley Ainslie and Liberton Hospitals, Edinburgh, Fitzgerald Alastair , Jamieson Andrew , Lange Peter , McIntosh Andrew , Morrison Lewis , Todd Iain 
Published: November 2020

Background

Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume.

Aims

In a community-based study, we aimed to investigate the existence, strength, direction, and independence of associations between intracerebral hemorrhage and peri-hematomal edema volumes on diagnostic brain CT and one-year functional outcome and long-term survival.

Methods

We identified all adults, resident in Lothian, diagnosed with first-ever, symptomatic spontaneous intracerebral hemorrhage between June 2010 and May 2013 in a community-based, prospective inception cohort study. We defined regions of interest manually and used a semi-automated approach to measure intracerebral hemorrhage volume, peri-hematomal edema volume, and the sum of these measurements (total lesion volume) on first diagnostic brain CT performed at ≤3 days after symptom onset. The primary outcome was death or dependence (scores 3–6 on the modified Rankin Scale) at one-year after intracerebral hemorrhage.

Results

Two hundred ninety-two (85%) of 342 patients (median age 77.5 y, IQR 68–83, 186 (54%) female, median time from onset to CT 6.5 h (IQR 2.9–21.7)) were dead or dependent one year after intracerebral hemorrhage. Peri-hematomal edema and intracerebral hemorrhage volumes were colinear ( R2 = 0.77). In models using both intracerebral hemorrhage and peri-hematomal edema, 10 mL increments in intracerebral hemorrhage (adjusted odds ratio (aOR) 1.72 (95% CI 1.08–2.87); p = 0.029) but not peri-hematomal edema volume (aOR 0.92 (0.63–1.45); p = 0.69) were independently associated with one-year death or dependence. 10 mL increments in total lesion volume were independently associated with one-year death or dependence (aOR 1.24 (1.11–1.42); p = 0.0004).

Conclusion

Total volume of intracerebral hemorrhage and peri-hematomal edema, and intracerebral hemorrhage volume alone on diagnostic brain CT, undertaken at three days or sooner, are independently associated with death or dependence one-year after intracerebral hemorrhage, but peri-hematomal edema volume is not.

Data access statement

Anonymized summary data may be requested from the corresponding author.