Predictors of Post-admission Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage

Abstract

Aim: Hematoma expansion (HE) is associated with poor outcome in patients with intracerebral hemorrhage (ICH). The aim of this study was to investigate the factors associated with HE. Materials and methods: We conducted a retrospective study of consecutive patients with spontaneous ICH. Patients were classified according to post-admission HE. Clinical and radiologic factors were compared and predictors of HE were analyzed by multiple logistic regression analysis. Results: Out of 207 patients, 115 were included in the final analysis. HE was detected in 29 patients (25.2%) on follow-up CT. Among patients with HE, the mean ICH volume was 31.24 mL, the mean follow-up volume was 53.97 mL, and the mean expansion rate was 152.11%. The GCS scores at presentation was lower ICH scores was higher and time interval from symptom onset to CT angiography (CTA) was shorter in patients with HE (p<0.001, p<0.001 and p=0.011, respectively). Radiologic features of hematoma such as spot sign, blend sign, and pleomorphic shape were more frequently present in patients with HE than those without HE. Multiple logistic regression analysis indicated that spot sign, blend sign, pleomorphic shape, and initial hematoma volume (≥30 mL) were independent predictors of hematoma expansion. Conclusion: In univariate analysis, lower GCS score at admission, higher ICH score, shorter time interval from symptom onset to CT, spot sign, blend sign, pleomorphic shape and large hematoma were associated with HE. More intensive cares should be considered to attenuate HE in at-risk patients.