Hematoma Growth as a Determinant of

Mortality in ICH
Monisha Kumar, MD reviewing Davis SM et al. Neurology 2006 Apr 25.
Growth in the first 24 hours was independently associated with increased mortality during
follow-up.
Spontaneous intracerebral hemorrhage (ICH) accounts for only 15% of strokes but has a 50%
mortality rate. Initial hematoma volume is a critical, though unmodifiable, determinant of
mortality. Recent research on the pathophysiology of ICH implicates hematoma expansion in
clinical deterioration. In this study, researchers aimed to determine whether hematoma growth
was associated with increased mortality independent of initial hemorrhage volume.
The authors performed a meta-analysis of 218 ICH patients who underwent CT within 3 hours
after symptom onset and again at 24 hours to detect hematoma growth. Participants were 115
placebo recipients pooled from clinical trials of recombinant activated factor VIIa (rFVIIa), in
which clinical outcomes were measured at 90 days, and another 103 untreated patients who were
assessed clinically at 4 to 6 weeks in a community-based study from Cincinnati. The researchers
examined previously identified factors associated with poor outcome, including age, sex, blood
pressure, blood glucose, Glasgow Coma Scale (GCS) score, and presence of intraventricular
hemorrhage (IVH). Some of the study authors have financial ties to the manufacturer of rFVIIa.
Although some hematoma growth occurred in 70% of patients, significant expansion (a >33%
increase) occurred in 28% of rFVIIa patients and in 35% of Cincinnati patients. Lower GCS
score, older age, and IVH were associated with poor outcomes. Independent of other factors, for
each 1-mL increase in baseline ICH volume and for each 10% increase in growth, patients were
6% and 16% more likely, respectively, to have a 1-point increase on the modified Rankin Scale.
Similarly, for every 10% increase in ICH growth, the risk for death during follow-up increased
by 5%.
- See more at: http://www.jwatch.org/jn200612120000002/2006/12/12/hematoma-growthdeterminant-mortality-ich#sthash.Nnvtk9bi.dpuf