Law, ZK, Ali, A, Krishnan, K, Bischoff, A, Appleton, JP, Scutt, P, Woodhouse, L, Pszczolkowski, S, Cala, LA, Dineen, RA, England, TJ, Ozturk, S, Roffe, C, Bereczki, D, Ciccone, A, Christensen, H, Ovesen, C, Bath, PM and Sprigg, N (2020) Noncontrast Computed Tomography Signs as Predictors of Hematoma Expansion, Clinical Outcome, and Response to Tranexamic Acid in Acute Intracerebral Hemorrhage. Stroke, 51 (1). pp. 121-128.

[img]
Preview
Text
STROKEAHA.119.026128.pdf - Published Version
Available under License Creative Commons Attribution.

Download (373kB) | Preview

Abstract

Background and Purpose— Blend, black hole, island signs, and hypodensities are reported to predict hematoma expansion in acute intracerebral hemorrhage. We explored the value of these noncontrast computed tomography signs in predicting hematoma expansion and functional outcome in our cohort of intracerebral hemorrhage. Methods— The TICH-2 (Tranexamic acid for IntraCerebral Hemorrhage-2) was a prospective randomized controlled trial exploring the efficacy and safety of tranexamic acid in acute intracerebral hemorrhage. Baseline and 24-hour computed tomography scans of trial participants were analyzed. Hematoma expansion was defined as an increase in hematoma volume of >33% or >6 mL on 24-hour computed tomography. Poor functional outcome was defined as modified Rankin Scale of 4 to 6 at day 90. Multivariable logistic regression was performed to identify predictors of hematoma expansion and poor functional outcome. Results— Of 2325 patients recruited, 2077 (89.3%) had valid baseline and 24-hour scans. Five hundred seventy patients (27.4%) had hematoma expansion while 1259 patients (54.6%) had poor functional outcome. The prevalence of noncontrast computed tomography signs was blend sign, 366 (16.1%); black hole sign, 414 (18.2%); island sign, 200 (8.8%); and hypodensities, 701 (30.2%). Blend sign (adjusted odds ratio [aOR] 1.53 [95% CI, 1.16–2.03]; P=0.003), black hole (aOR, 2.03 [1.34–3.08]; P=0.001), and hypodensities (aOR, 2.06 [1.48–2.89]; P<0.001) were independent predictors of hematoma expansion on multivariable analysis with adjustment for covariates. Black hole sign (aOR, 1.52 [1.10–2.11]; P=0.012), hypodensities (aOR, 1.37 [1.05–1.78]; P=0.019), and island sign (aOR, 2.59 [1.21–5.55]; P=0.014) were significant predictors of poor functional outcome. Tranexamic acid reduced the risk of hematoma expansion (aOR, 0.77 [0.63–0.94]; P=0.010), but there was no significant interaction between the presence of noncontrast computed tomography signs and benefit of tranexamic acid on hematoma expansion and functional outcome (P interaction all >0.05). Conclusions— Blend sign, black hole sign, and hypodensities predict hematoma expansion while black hole sign, hypodensities, and island signs predict poor functional outcome. Noncontrast computed tomography signs did not predict a better response to tranexamic acid. Clinical Trial Registration— URL: https://www.isrctn.com. Unique identifier: ISRCTN93732214.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via American Heart Association at http://doi.org/10.1161/STROKEAHA.119.026128 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: cerebral hemorrhage, hematoma, odds ratio, prevalence, probability, tranexamic acid
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Applied Clinical Sciences
Depositing User: Symplectic
Date Deposited: 22 Nov 2019 14:28
Last Modified: 31 Jan 2020 12:18
URI: http://eprints.keele.ac.uk/id/eprint/7281

Actions (login required)

View Item View Item