TY - JOUR
T1 - Relationship of White Matter Lesions with Intracerebral Hemorrhage Expansion and Functional Outcome
T2 - MISTIE II and CLEAR III
AU - For the MISTIE and CLEAR Investigators
AU - Hansen, Björn M.
AU - Ullman, Natalie
AU - Muschelli, John
AU - Norrving, Bo
AU - Dlugash, Rachel
AU - Avadhani, Radhika
AU - Awad, Issam
AU - Zuccarello, Mario
AU - Ziai, Wendy C.
AU - Hanley, Daniel F.
AU - Thompson, Richard E.
AU - Lindgren, Arne
N1 - Funding Information:
We thank participating patients and families and the staff and PIs from contributing centers as mentioned in the original publications [25 ?27]. We also thank Nichol McBee and Karen Lane at the Division of Brain Injury Outcomes at Johns Hopkins University, for administrative support.
Funding Information:
CLEAR III (U01NS062851) and MISTIE II (R01NS046309) were supported by Grants awarded to Dr. Hanley by the National Institutes of Health National Institute of Neurological Disorders and Stroke. Genentech donated alteplase. Dr. Hanley is supported by the National Institutes of Health (U01NS080824 and U24TR001609). Dr. Lindgren is supported by the Swedish Heart and Lung Foundation, Skåne University Hospital; the Freemasons Lodge of Instruction EOS, Lund University; and the Swedish Stroke Association. Dr. Norrving is supported by Stiftelsen Färs and Frosta Sparbank. Acknowledgments
Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background/Objective: Intracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials. Methods: In ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT, ' 24 h after ictus) was assessed using the van Swieten scale (vSS, range 0–4). The primary outcome for HE was ' 33% or ' 6 mL ICH volume increase from dCT to the last pre-randomization CT (' 72 h of dCT). Secondary HE outcomes were: absolute ICH expansion, ' 10.4 mL total clot volume increase, and a subgroup analysis including patients with dCT ' 6 h after ictus using the primary HE definition of ' 33% or ' 6 mL ICH volume increase. Poor functional outcome was assessed at 180 days and defined as modified Rankin Scale (mRS) ≥ 4, with ordinal mRS as a secondary endpoint. Results: Of 635 patients, 55% had WML grade 1–4 at dCT (median 2.2 h from ictus) and 13% had subsequent HE. WML at dCT did not increase the odds for primary or secondary HE endpoints (P ≥ 0.05) after adjustment for ICH volume, intraventricular hemorrhage volume, warfarin/INR ' 1.5, ictus to dCT time in hours, age, diabetes mellitus, and thalamic ICH location. WML increased the odds for having poor functional outcome (mRS ≥ 4) in univariate analyses (vSS 4; OR 4.16; 95% CI 2.54–6.83; P ' 0.001) which persisted in multivariable analyses after adjustment for HE and other outcome risk factors. Conclusions: Concomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome. Clinical Trial Registration: http://www.clinicaltrials.gov trial-identifiers: NCT00224770 and NCT00784134.
AB - Background/Objective: Intracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials. Methods: In ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT, ' 24 h after ictus) was assessed using the van Swieten scale (vSS, range 0–4). The primary outcome for HE was ' 33% or ' 6 mL ICH volume increase from dCT to the last pre-randomization CT (' 72 h of dCT). Secondary HE outcomes were: absolute ICH expansion, ' 10.4 mL total clot volume increase, and a subgroup analysis including patients with dCT ' 6 h after ictus using the primary HE definition of ' 33% or ' 6 mL ICH volume increase. Poor functional outcome was assessed at 180 days and defined as modified Rankin Scale (mRS) ≥ 4, with ordinal mRS as a secondary endpoint. Results: Of 635 patients, 55% had WML grade 1–4 at dCT (median 2.2 h from ictus) and 13% had subsequent HE. WML at dCT did not increase the odds for primary or secondary HE endpoints (P ≥ 0.05) after adjustment for ICH volume, intraventricular hemorrhage volume, warfarin/INR ' 1.5, ictus to dCT time in hours, age, diabetes mellitus, and thalamic ICH location. WML increased the odds for having poor functional outcome (mRS ≥ 4) in univariate analyses (vSS 4; OR 4.16; 95% CI 2.54–6.83; P ' 0.001) which persisted in multivariable analyses after adjustment for HE and other outcome risk factors. Conclusions: Concomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome. Clinical Trial Registration: http://www.clinicaltrials.gov trial-identifiers: NCT00224770 and NCT00784134.
KW - Cerebral hemorrhage
KW - Cerebral small vessel diseases
KW - Leukoaraiosis
KW - Leukoencephalopathies
KW - Prognosis
KW - Stroke
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U2 - 10.1007/s12028-020-00916-4
DO - 10.1007/s12028-020-00916-4
M3 - Article
C2 - 32026447
AN - SCOPUS:85079193712
VL - 33
SP - 516
EP - 524
JO - Neurocritical Care
JF - Neurocritical Care
SN - 1541-6933
IS - 2
ER -