Multivariate analysis of risk factors of hematoma expansion in spontaneous intracerebral hemorrhage

• Published in: Surgical neurology 2008, Vol.69 (1), p.40-45
• Main Authors: Lim, Jae Kwan, MD, Hwang, Hyung Sik, MD, Cho, Byung Moon, MD, Lee, Ho Kook, MD, Ahn, Sung Ki, MD, Oh, Sae Moon, MD, Choi, Sun Kil, MD
• Format: Article
• Language: English
• Subjects: Anticoagulants - adverse effects; Blood Pressure - physiology; Cerebral Hemorrhage - etiology; Cerebral Hemorrhage - pathology; Diastolic blood pressure; Female; Glasgow Outcome Scale; Hematoma - etiology; Hematoma - pathology; Hematoma expansion; Humans; Logistic Models; Male; Middle Aged; Neurology; Odds Ratio; Retrospective Studies; Risk Factors; Spontaneous intracerebral hemorrhage; Surgery; Time Factors
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2007.07.025

Abstract Back ground We focused on the cause of hematoma expansion after admission because the volume of hematoma after S-ICH plays a crucial role in the cause of mortality and morbidity. Methods In a retrospective review, 51 patients with hematoma expansion of S-ICH were identified among 880 cases of S-ICH treated between 2001 and May 2006. We divided cases into 2 groups according to the time of hematoma expansion. An enlargement of hematoma within 2 weeks after hospitalization was categorized as the acute stage group and after 2 weeks was categorized as the chronic stage group. Spontaneous intracerebral hemorrhage without hematoma expansion group (100 cases) had been consecutively selected as a control group. We analyzed the risk factors of hematoma expansion in patients with S-ICH especially in the acute stage group. Results Fifty-one of 880 patients had the enlargement of hematoma (5.8%). Forty-three (84%) of 51 cases were acutely developed and 8 cases (16%) were developed chronically. On univariate analysis there were significant differences in BP within the initial 48 hours ( P < .0001), GOS ( P < .0001), and previously taking anticoagulant agents ( P = .0053). Especially the difference in SBP and DBP within 48 hours between groups was 19 (11%) and 13 mm Hg (14%), respectively. The DBP within the initial 24 hours had a meaningful odds ratio (1.06) on logistic regression analysis. Conclusion A reduction of BP by 15% (SBP ≤140 mm Hg, DBP ≤80 mm Hg) is necessary at acute stage in S-ICH.