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Original Investigation |

Predictors of Hematoma Volume in Deep and Lobar Supratentorial Intracerebral Hemorrhage

Guido J. Falcone, MD, MPH1,2,3,5,6; Alessandro Biffi, MD1,2,3,5; H. Bart Brouwers, MD1,2,3,5; Christopher D. Anderson, MD1,2,3,5; Thomas W. K. Battey, BS1,2,3,5; Alison M. Ayres, BA2; Anastasia Vashkevich, BA2; Kristin Schwab, BA2; Natalia S. Rost, MD, MPH1,2,3,5; Joshua N. Goldstein, MD, PhD4; Anand Viswanathan, MD, PhD2; Steven M. Greenberg, MD, PhD2; Jonathan Rosand, MD, MSc1,2,3,5
[+] Author Affiliations
1Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts
2Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, Massachusetts
3Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
4Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
5Program in Medical and Population Genetics, Broad Institute, Massachusetts General Hospital, Cambridge, Massachusetts
6Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
JAMA Neurol. 2013;70(8):988-994. doi:10.1001/jamaneurol.2013.98.
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Importance  Hematoma volume is the strongest predictor of outcome in intracerebral hemorrhage (ICH). Despite known differences in the underlying biology between deep and lobar ICHs, limited data are available on location specificity of factors reported to affect hematoma volume.

Objective  To evaluate whether determinants of ICH volume differ by topography, we sought to estimate location-specific effects for potential predictors of this radiological outcome.

Design  Prospective cohort study.

Setting  Academic medical center.

Participants  A total of 744 supratentorial primary ICH patients (388 deep and 356 lobar) aged older than 18 years admitted between January 1, 2000, and December 31, 2010.

Main Outcomes and Measures  Intracerebral hemorrhage volume measured from the computed tomography scan obtained on presentation to the emergency department. Linear regression analysis, stratified by ICH location, was implemented to identify determinants of log-transformed ICH volume.

Results  Median ICH volume was larger in lobar hemorrhages (39 mL; interquartile range, 16-75 mL) than in deep hemorrhages (13 mL; interquartile range, 5-40 mL; P < .001). In multivariable linear regression, independent predictors of deep ICH volume were intensity of anticoagulation (β = 0.32; standard error [SE] = 0.08; P < .001; test for trend across 4 categories of the international normalized ratio), history of coronary artery disease (β = 0.33; SE = 0.17; P = .05), male sex (β = 0.28; SE = 0.14; P = .05), and age (β = −0.02; SE = 0.01; P = .001). Independent predictors of lobar ICH volume were intensity of anticoagulation (β = 0.14; SE = 0.06; P = .02) and antiplatelet treatment (β = 0.27; SE = 0.13; P = .03).

Conclusions and Relevance  Predictors of hematoma volume only partially overlap between deep and lobar ICHs. These findings suggest that the mechanisms that determine the extent of bleeding differ for deep and lobar ICHs. Further studies are needed to characterize the specific biological pathways that underlie the observed associations.

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Predicted Intracerebral Hemorrhage (ICH) Volume By International Normalized Ratio (INR) Categories

Predicted log-mean hematoma volume applying the fitted models. Results are presented stratified by INR category and by ICH location.

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