Multivariate Analysis of Predictors of Hematoma Enlargement in Spontaneous Intracerebral Hemorrhage

TLDR

The study aimed to identify independent predictors of hematoma enlargement after admission in spontaneous intracerebral hemorrhage patients using multivariate analysis. The authors reviewed 627 ICH patients, performed serial CT scans within 24 h and collected laboratory data, then used univariate and multivariate analyses to evaluate factors associated with hematoma enlargement. Multivariate analysis identified five independent predictors of hematoma enlargement—shorter time from onset, higher alcohol intake, irregular hematoma shape, consciousness disturbance, and lower fibrinogen level—and found that enlargement independently increased mortality.

Abstract

We conducted this study to determine, through use of multivariate analyses, the independent predictors of hematoma enlargement occurring after hospital admission in patients with spontaneous intracerebral hemorrhage (i.c.h.).We reviewed 627 patients with ICH admitted within 24 hours of onset. The first CT was performed at admission and the second within 24 hours of admission, and a blood sample was taken for laboratory examinations. Univariate and multivariate analyses were performed to assess the relationships between hematoma enlargement and time from onset, consciousness level, CT findings, amount of alcohol consumption, systolic blood pressure at and after admission, clinical outcome, and hematologic parameters.Eighty-eight patients (14.0%) showed enlarged hematomas after admission. Multivariate analyses revealed that the following five factors were independently associated with hematoma enlargement: the time from onset (odds ratio [OR], 0.26 for a 1-SD change; 4.9 hours; P < 0.001); the amount of alcohol consumption (OR, 1.50 for 1 SD; 46.3 g/d; P = 0.002); the sharp of hematoma (OR, 1.40 for 1 SD; 0.45 round; P = 0.006); the presence of consciousness disturbance (OR, 1.38 for 1 SD; 0.50 coma; P = 0.026); and the level of fibrinogen (OR, 0.74 for 1 SD; 87.1 mg/dL; P = 0.042). Hematoma enlargement was an independent factor increasing the mortality rate in the ICH patients (OR, 1.57; P < 0.001).A particularly high likelihood of hematoma enlargement was observed in patients who (in order of importance) were admitted shortly after onset, who were heavy drinkers; who had an irregularly shaped hematoma, whose consciousness was disturbed, and who had a low level of fibrinogen.