Association Between Perihematomal Perfusion and Intracerebral Hemorrhage Outcome
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ORIGINAL WORK (CLINICAL INVESTIGATION, BASIC SCIENCE)
Association Between Perihematomal Perfusion and Intracerebral Hemorrhage Outcome Andrea Morotti1* , Giorgio Busto2, Andrea Bernardoni3, Sandro Marini4, Ilaria Casetta5 and Enrico Fainardi6 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: The prognostic impact of perihematomal hypoperfusion in patients with acute intracerebral hemorrhage (ICH) remains unclear. We tested the hypothesis that perihematomal hypoperfusion predicts poor ICH outcome and explored whether hematoma growth (HG) is the pathophysiological mechanism behind this association. Methods: A prospectively collected single-center cohort of consecutive ICH patients undergoing computed tomography perfusion on admission was analyzed. Cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area. pCBF was categorized into normal (40–55 mL/100 g/min), low ( 55 mL/100 g/min). HG was calculated as total volume increase from baseline to follow-up CT. A modified Rankin scale > 2 at three months was the outcome of interest. The association between cerebral perfusion and outcome was investigated with logistic regression, and potential mediators of this relationship were explored with mediation analysis. Results: A total of 155 subjects were included, of whom 55 (35.5%) had poor outcome. The rates of normal pCBF, low pCBF, and high pCBF were 17.4%, 68.4%, and 14.2%, respectively. After adjustment for confounders and keeping subjects with normal pCBF as reference, the risk of poor outcome was increased in patients with pCBF 2.5 mL/100 g), and MTT was dichotomized into normal (≤ 5 s) and high (> 5 s).
Fig. 1 CT perfusion acquisition. Hematoma topography on averaged computed tomography perfusion images (panel A) and perihematomal perfusion mapping with cerebral blood flow (panel B) in a patient with acute spontaneous intracerebral hemorrhage located in left temporal lobe
Statistical Analysis
Continuous variables were summarized as median (interquartile range, IQR) or mean (standard deviation, SD) based on their distribution (tested with Kolmogorov–Smirnoff test) and compared with Mann–Whitney/ Kruskal–Wallis or t test/ANOVA as appropriate. Categorical variables were summarized as count (percentage) and compared using the χ2 test. Unadjusted correlations were evaluated with Spearman test. Partial correlation was used to explore correlations between log-transformed continuous variables after controlling for confounders. Predictors of poor functional outcome, defined as mRS > 2 at three months from the index event [16], were investigated with multivariable logistic regression. Models 1 and 2 were adjusted for the modified ICH score [17], a validated tool to predict poor outcome after ICH, and for HG. In a secondary analysis, the logistic regression models included also all variables with p 3 at three months [18]. CBF, CBV, and MTT values in the perihematomal area were analyzed both as continuous varia
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