Abstract
Background
Hematoma expansion in intracerebral hemorrhage (ICH) is a predictor of poor outcome and remains an important therapeutic target. Little is known about the incidence and clinical characteristics of patients with severe hematoma expansion, who we hereafter label as super-expanders.
Methods
We retrospectively reviewed baseline clinical and radiological features in consecutive ICH patients admitted over a three-year period to a comprehensive stroke center. Hematoma expansion was defined conventionally as a > 33% increase in hematoma volume or a > 6ml increase in absolute hematoma volume between the baseline and 24h follow brain CT. Severe hematoma expansion was defined as a > 50% increase in ICH volume associated with a decrease in the Glasgow Coma Scale of at least four points. We used Random Forest (RF) to generate importance plots searching for the determinants of super-expanders in ICH. In addition, a multivariable logistic regression model was done to examine independent factors associated with super-expanders.
Results
We analyzed 417 cases. Hematoma expansion, defined conventionally, occurred in 97/417 (23%) patients of which 15/417 (4%) were super-expanders. In the univariate analysis, super-expanders were more likely to have a lobar hemorrhage, a spot sign and had increased in-hospital mortality. Using the Random Forrest analysis, age, platelet count and presence of a spot-sign emerged as important determinants of super-expansion. In a multivariable model, only spot sign was an independent predictor for super expansion [Age (OR = 1.43, CI = 0.61, 3.37), spot sign (OR = 6.25, CI = 2.30–17.00), lobar location (OR = 4.63, CI = 0.92–23.42)].
Conclusion
We describe a low incidence of 4% of severe hematoma expansion in ICH. Age, platelets count, and the spot sign were important determinants of the super-expanders. We encourage further investigations into the early identification of super-expanders who arguably have the most to benefit from aggressive interventions.