Prognostic Significance of Perihematomal Edema in Acute Intracerebral Hemorrhage

Pooled Analysis from the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies

Jie Yang, Hisatomi Arima, Guojun Wu, Emma Heeley, Candice Delcourt, Junshan Zhou, Guofang Chen, Xia Wang, Shihong Zhang, Sungwook Yu, John Chalmers, Craig S. Anderson

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background and Purpose-Controversy exists over the prognostic significance of perihematomal edema (PHE) in intracerebral hemorrhage. We aimed to determine the association of early PHE and clinical outcome among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods-Pooled analyses of computed tomographic substudies in the pilot phase (INTERACT1) and main phase (INTERACT2), both international, prospective, open, blinded end point, randomized controlled trials, of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic blood pressure, randomly assigned to intensive (target systolic blood pressure, <140 mm Hg) or guideline-based (systolic blood pressure, <180 mm Hg) blood-pressure management. Substudy participants (n=1310; 346 INTERACT1, 964 INTERACT2) had blinded central analyses of digital images from standardized baseline and 24-hour computed tomography. Predictors of death or dependency (modified Rankin scale scores, ≥3) at 90 days were assessed in logistic regression models and reported with odds ratios and 95% confidence intervals. INTERACT studies are registered at ClinicalTrials.gov (NCT00226096 and NCT00716079). Results-Of 1138 (87%) patients with 2 CTs available for edema analysis and outcome information, time from intracerebral hemorrhage onset to baseline computed tomography, baseline hematoma volume, 24-hour hematoma growth, and intraventricular extension were independent predictors of 24-hour PHE growth. Absolute growth in PHE volume was significantly associated with death or dependency (adjusted odds ratio, 1.17; 95% confidence interval, 1.02-1.33 per 5 mL increase from baseline; P=0.025) at 90 days after adjustment for demographic, clinical, and hematoma parameter prognostic factors. Associations were consistent across various sensitivity analyses. Conclusion-PHE growth is an independent prognostic factor in intracerebral hemorrhage.

Original languageEnglish
Pages (from-to)1009-1013
Number of pages5
JournalStroke
Volume46
Issue number4
DOIs
Publication statusPublished - 2015 Jan 1

Fingerprint

Cerebral Hemorrhage
Edema
Blood Pressure
Hematoma
Growth
Logistic Models
Odds Ratio
Tomography
Confidence Intervals
Randomized Controlled Trials
Demography
Guidelines

Keywords

  • cerebral hemorrhage
  • clinical trial
  • hypertension

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Prognostic Significance of Perihematomal Edema in Acute Intracerebral Hemorrhage : Pooled Analysis from the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies. / Yang, Jie; Arima, Hisatomi; Wu, Guojun; Heeley, Emma; Delcourt, Candice; Zhou, Junshan; Chen, Guofang; Wang, Xia; Zhang, Shihong; Yu, Sungwook; Chalmers, John; Anderson, Craig S.

In: Stroke, Vol. 46, No. 4, 01.01.2015, p. 1009-1013.

Research output: Contribution to journalArticle

Yang, Jie ; Arima, Hisatomi ; Wu, Guojun ; Heeley, Emma ; Delcourt, Candice ; Zhou, Junshan ; Chen, Guofang ; Wang, Xia ; Zhang, Shihong ; Yu, Sungwook ; Chalmers, John ; Anderson, Craig S. / Prognostic Significance of Perihematomal Edema in Acute Intracerebral Hemorrhage : Pooled Analysis from the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies. In: Stroke. 2015 ; Vol. 46, No. 4. pp. 1009-1013.
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abstract = "Background and Purpose-Controversy exists over the prognostic significance of perihematomal edema (PHE) in intracerebral hemorrhage. We aimed to determine the association of early PHE and clinical outcome among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods-Pooled analyses of computed tomographic substudies in the pilot phase (INTERACT1) and main phase (INTERACT2), both international, prospective, open, blinded end point, randomized controlled trials, of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic blood pressure, randomly assigned to intensive (target systolic blood pressure, <140 mm Hg) or guideline-based (systolic blood pressure, <180 mm Hg) blood-pressure management. Substudy participants (n=1310; 346 INTERACT1, 964 INTERACT2) had blinded central analyses of digital images from standardized baseline and 24-hour computed tomography. Predictors of death or dependency (modified Rankin scale scores, ≥3) at 90 days were assessed in logistic regression models and reported with odds ratios and 95{\%} confidence intervals. INTERACT studies are registered at ClinicalTrials.gov (NCT00226096 and NCT00716079). Results-Of 1138 (87{\%}) patients with 2 CTs available for edema analysis and outcome information, time from intracerebral hemorrhage onset to baseline computed tomography, baseline hematoma volume, 24-hour hematoma growth, and intraventricular extension were independent predictors of 24-hour PHE growth. Absolute growth in PHE volume was significantly associated with death or dependency (adjusted odds ratio, 1.17; 95{\%} confidence interval, 1.02-1.33 per 5 mL increase from baseline; P=0.025) at 90 days after adjustment for demographic, clinical, and hematoma parameter prognostic factors. Associations were consistent across various sensitivity analyses. Conclusion-PHE growth is an independent prognostic factor in intracerebral hemorrhage.",
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AU - Arima, Hisatomi

AU - Wu, Guojun

AU - Heeley, Emma

AU - Delcourt, Candice

AU - Zhou, Junshan

AU - Chen, Guofang

AU - Wang, Xia

AU - Zhang, Shihong

AU - Yu, Sungwook

AU - Chalmers, John

AU - Anderson, Craig S.

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