Relationship of White Matter Lesions with Intracerebral Hemorrhage Expansion and Functional Outcome : MISTIE II and CLEAR III
(2020) In Neurocritical Care 33(2). p.516-524- Abstract
Background/Objective: Intracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials. Methods: In ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT, < 24 h after ictus) was assessed using the van Swieten scale (vSS, range 0–4). The primary outcome for HE was > 33% or > 6 mL ICH volume increase from dCT to the last pre-randomization CT (< 72 h of dCT). Secondary HE outcomes were: absolute ICH expansion, > 10.4 mL total clot... (More)
Background/Objective: Intracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials. Methods: In ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT, < 24 h after ictus) was assessed using the van Swieten scale (vSS, range 0–4). The primary outcome for HE was > 33% or > 6 mL ICH volume increase from dCT to the last pre-randomization CT (< 72 h of dCT). Secondary HE outcomes were: absolute ICH expansion, > 10.4 mL total clot volume increase, and a subgroup analysis including patients with dCT < 6 h after ictus using the primary HE definition of > 33% or > 6 mL ICH volume increase. Poor functional outcome was assessed at 180 days and defined as modified Rankin Scale (mRS) ≥ 4, with ordinal mRS as a secondary endpoint. Results: Of 635 patients, 55% had WML grade 1–4 at dCT (median 2.2 h from ictus) and 13% had subsequent HE. WML at dCT did not increase the odds for primary or secondary HE endpoints (P ≥ 0.05) after adjustment for ICH volume, intraventricular hemorrhage volume, warfarin/INR > 1.5, ictus to dCT time in hours, age, diabetes mellitus, and thalamic ICH location. WML increased the odds for having poor functional outcome (mRS ≥ 4) in univariate analyses (vSS 4; OR 4.16; 95% CI 2.54–6.83; P < 0.001) which persisted in multivariable analyses after adjustment for HE and other outcome risk factors. Conclusions: Concomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome. Clinical Trial Registration: http://www.clinicaltrials.gov trial-identifers: NCT00224770 and NCT00784134.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2020-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cerebral hemorrhage, Cerebral small vessel diseases, Leukoaraiosis, Leukoencephalopathies, Prognosis, Stroke
- in
- Neurocritical Care
- volume
- 33
- issue
- 2
- pages
- 9 pages
- publisher
- Humana Press
- external identifiers
-
- scopus:85079193712
- pmid:32026447
- ISSN
- 1541-6933
- DOI
- 10.1007/s12028-020-00916-4
- language
- English
- LU publication?
- yes
- id
- dc691817-3afd-43a5-91b7-c917958852b4
- date added to LUP
- 2020-02-21 13:50:25
- date last changed
- 2024-05-01 05:51:26
@article{dc691817-3afd-43a5-91b7-c917958852b4,
abstract = {{<p>Background/Objective: Intracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials. Methods: In ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT, < 24 h after ictus) was assessed using the van Swieten scale (vSS, range 0–4). The primary outcome for HE was > 33% or > 6 mL ICH volume increase from dCT to the last pre-randomization CT (< 72 h of dCT). Secondary HE outcomes were: absolute ICH expansion, > 10.4 mL total clot volume increase, and a subgroup analysis including patients with dCT < 6 h after ictus using the primary HE definition of > 33% or > 6 mL ICH volume increase. Poor functional outcome was assessed at 180 days and defined as modified Rankin Scale (mRS) ≥ 4, with ordinal mRS as a secondary endpoint. Results: Of 635 patients, 55% had WML grade 1–4 at dCT (median 2.2 h from ictus) and 13% had subsequent HE. WML at dCT did not increase the odds for primary or secondary HE endpoints (P ≥ 0.05) after adjustment for ICH volume, intraventricular hemorrhage volume, warfarin/INR > 1.5, ictus to dCT time in hours, age, diabetes mellitus, and thalamic ICH location. WML increased the odds for having poor functional outcome (mRS ≥ 4) in univariate analyses (vSS 4; OR 4.16; 95% CI 2.54–6.83; P < 0.001) which persisted in multivariable analyses after adjustment for HE and other outcome risk factors. Conclusions: Concomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome. Clinical Trial Registration: http://www.clinicaltrials.gov trial-identifers: NCT00224770 and NCT00784134.</p>}},
author = {{Hansen, Björn M. and Ullman, Natalie and Muschelli, John and Norrving, Bo and Dlugash, Rachel and Avadhani, Radhika and Awad, Issam and Zuccarello, Mario and Ziai, Wendy C. and Hanley, Daniel F. and Thompson, Richard E. and Lindgren, Arne}},
issn = {{1541-6933}},
keywords = {{Cerebral hemorrhage; Cerebral small vessel diseases; Leukoaraiosis; Leukoencephalopathies; Prognosis; Stroke}},
language = {{eng}},
number = {{2}},
pages = {{516--524}},
publisher = {{Humana Press}},
series = {{Neurocritical Care}},
title = {{Relationship of White Matter Lesions with Intracerebral Hemorrhage Expansion and Functional Outcome : MISTIE II and CLEAR III}},
url = {{http://dx.doi.org/10.1007/s12028-020-00916-4}},
doi = {{10.1007/s12028-020-00916-4}},
volume = {{33}},
year = {{2020}},
}