Perihematomal Edema Expansion Rate Predicts Functional Outcome in Deep Intracerebral Hemorrhage (S31.008)

Objective: To compare associations between perihematomal edema (PHE) expansion rate and poor functional outcome following deep or lobar intracerebral hemorrhage (ICH). Background: PHE expansion rate may predict functional outcome after ICH, but no studies have investigated whether ICH location affects this association. Methods: Subjects (n=139) were retrospectively identified from a prospective ICH cohort enrolled from 2000-2013. Inclusion criteria: >18 years old, spontaneous supratentorial ICH, and known time of onset. Exclusion criteria: infratentorial or primary intraventricular hemorrhage, subsequent surgery, trauma, or warfarin-related ICH. ICH, PHE, and intraventricular hemorrhage (IVH) volumes were measured from CT scans. PHE expansion rates were calculated from serial volume measurements. Logistic regression assessed the association between PHE expansion rate and mortality or poor functional outcome (modified Rankin Scale >2) at 90 days. Odds ratios are per 0.04 mL/h. Results: PHE expansion rate from baseline to 24 hours (PHE24) predicts mortality for deep (p=0.03, OR 1.13[1.02-1.26]) and lobar ICH (p=0.02, OR 1.03[1.00-1.06]) in unadjusted regression, and in models adjusted for age (Deep: p=0.02; Lobar: p=0.03), blood pressure (Deep: p=0.02; Lobar: p=0.04), IVH volume (Deep: p=0.02; Lobar: p=0.05), Glasgow Coma Scale (Deep: p=0.03; Lobar: p=0.02), or time to baseline CT (Deep: p=0.05; Lobar: p=0.05). A significant interaction exists between ICH location and PHE expansion rate from baseline to 72 hours (PHE72) in models predicting mRS>2 (p=0.04). PHE72 predicts mRS>2 for deep but not lobar ICH (p-values not shown) in models that are unadjusted (p=0.02, OR 4.04[1.25-13.04]) or adjusted for ICH volume (p=0.02, OR 4.3[1.25-14.98]), age (p=0.03, OR 5.4[1.21-24.11]), blood pressure (p=0.05, OR 3.28[1.02-10.57]), IVH volume (p=0.02, OR 4.59[1.28-16.41]), GCS (p=0.02, OR 4.19[1.2-14.55]), or time to first CT (p=0.03, OR 4.02[1.19-13.56]). Conclusions: PHE72 predicts poor functional outcomes exclusively after deep ICH, whereas PHE24 predicts mortality for deep and lobar ICH. Disclosure: Dr. Grunwald has nothing to disclose. Dr. Urday has nothing to disclose. Dr. Beslow has nothing to disclose. Dr. Vashkevich has nothing to disclose. Dr. Ayres has nothing to disclose. Dr. Greenberg has received personal compensation for activities with Hoffman-Laroche. Dr. Goldstein has nothing to disclose. Dr. Battey has nothing to disclose. Dr. Simard has received royalty payments from Remedy. Dr. Rosand has nothing to disclose. Dr. Kimberly has received research support from Remedy Pharmaceuticals, Inc. Dr. Sheth has nothing to disclose.