Hydrocephalus Growth: Definition, Prevalence, Association with Poor Outcome in Acute Intracerebral Hemorrhage
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ORIGINAL WORK
Hydrocephalus Growth: Definition, Prevalence, Association with Poor Outcome in Acute Intracerebral Hemorrhage Wen‑Song Yang1,2†, Yi‑Qing Shen1,2†, Xiao‑Dong Zhang3†, Li‑Bo Zhao4,5, Xiao Wei6, Xin Xiong7, Xiong‑Fei Xie8, Rui Li1, Lan Deng1, Xin‑Hui Li1, Xin‑Ni Lv1, Fa‑Jin Lv8, Qi Li1,2* and Peng Xie1,2* © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background/Objectives: To propose a novel definition for hydrocephalus growth and to further describe the asso‑ ciation between hydrocephalus growth and poor outcome among patients with intracerebral hemorrhage (ICH). Methods: We analyzed consecutive patients who presented within 6 h after ICH ictus between July 2011 and June 2017. Follow-up CT scans were performed within 36 h after initial CT scans. The degree of hydrocephalus were evalu‑ ated by the hydrocephalus score of Diringer et al. The optimal increase of the hydrocephalus scores between initial and follow-up CT scan was estimated to define hydrocephalus growth. Poor long-term outcome was defined as a modified Rankin Scale of 4–6 at 3 months. Multivariate logistic regression analysis was performed to investigate the hydrocephalus growth for predicting 30-day mortality, 90-day mortality, and poor long-term outcome. Results: A total of 321 patients with ICH were included in the study. Of 64 patients with hydrocephalus growth, 34 (53.1%) patients presented with both concurrent hematoma expansion and intraventricular hemorrhage (IVH) growth. After adjusting for potential confounding factors, hydrocephalus growth independently predicted 30-day mortality, 90-day mortality, and 90-day poor long-term outcome in multivariate logistic regression analysis. Hydro‑ cephalus growth showed higher accuracy for predicting 30-day mortality, 90-day mortality, and poor long-term outcome than IVH growth or hematoma expansion, respectively. Conclusions: Hydrocephalus growth is defined by strongly predictive of short- or long-term mortality and poor outcome at 90 days, and might be a potential indicator for assisting clinicians for clinical decision-making. Keywords: Intracerebral hemorrhage, Hydrocephalus, Outcome, Hematoma growth, Neuroimaging Introduction Intracerebral hemorrhage (ICH) is a major public health burden with high disability and mortality rates [1, 2]. The mortality rate of ICH patients ranges from 35% after 7 days to 59% after 1 year [3]. The outcome for recovery from acute ICH is strongly associated with several *Correspondence: [email protected]; [email protected] † Wen-Song Yang, Yi-Qing Shen and Xiao-Dong Zhang have contributed equally to this work. 1 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China Full list of author information is available at the end of the article
imaging criteria. These include hematoma volume, intraventricular hemorrhage (IVH), hematoma expansion, and IVH growth [4–7]. Hydrocephalus is a well-established predictor of poor outcome in ICH patient
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