Association between Computed Tomographic Biomarkers of Cerebral Small Vessel Diseases and Long‐Term Outcome after Spontaneous Intracerebral Hemorrhage

• Published in: Annals of neurology 2021-02, Vol.89 (2), p.266-279
• Main Authors: Rodrigues, Mark A., Samarasekera, Neshika, Lerpiniere, Christine, Perry, Luke A., Moullaali, Tom J., Loan, James, Wardlaw, Joanna M., Al‐Shahi Salman, Rustam
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Atrophy; Biomarkers; Brain; Brain - diagnostic imaging; Brain - pathology; Cerebral Small Vessel Diseases - diagnostic imaging; Cohort Studies; Computed tomography; Confidence intervals; Death; Dependence; Diagnostic systems; Female; Hemorrhage; Hemorrhagic Stroke - diagnostic imaging; Hemorrhagic Stroke - physiopathology; Humans; Logistic Models; Male; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Prognosis; Prospective Studies; Severity of Illness Index; Statistical analysis; Stroke, Lacunar - diagnostic imaging; Substantia alba; Tomography, X-Ray Computed; Vascular diseases; White Matter - diagnostic imaging
• ISSN: 0364-5134; 1531-8249; 1531-8249
• DOI: 10.1002/ana.25949

Objective A study was undertaken to assess whether cerebral small vessel disease (SVD) computed tomographic (CT) biomarkers are associated with long‐term outcome after intracerebral hemorrhage. Methods We performed a prospective, community‐based cohort study of adults diagnosed with spontaneous intracerebral hemorrhage between June 1, 2010 and May 31, 2013. A neuroradiologist rated the diagnostic brain CT for acute intracerebral hemorrhage features and SVD biomarkers. We used severity of white matter lucencies and cerebral atrophy, and the number of lacunes to calculate the CT SVD score. We assessed the association between CT SVD biomarkers and either death, or death or dependence (modified Rankin Scale scores = 4–6) 1 year after first‐ever intracerebral hemorrhage using logistic regression, adjusting for known predictors of outcome. Results Within 1 year of intracerebral hemorrhage, 224 (56%) of 402 patients died. In separate models, 1‐year death was associated with severe atrophy (adjusted odds ratio [aOR] = 2.54, 95% confidence interval [CI] = 1.44–4.49, p = 0.001) but not lacunes or severe white matter lucencies, and CT SVD sum score ≥ 1 (aOR = 2.50, 95% CI = 1.40–4.45, p = 0.002). Two hundred seventy‐seven (73%) of 378 patients with modified Rankin Scale data were dead or dependent at 1 year. In separate models, 1‐year death or dependence was associated with severe atrophy (aOR = 3.67, 95% CI = 1.71–7.89, p = 0.001) and severe white matter lucencies (aOR = 2.18, 95% CI = 1.06–4.51, p = 0.035) but not lacunes, and CT SVD sum score ≥ 1 (aOR = 2.81, 95% CI = 1.45–5.46, p = 0.002). Interpretation SVD biomarkers on the diagnostic brain CT are associated with 1‐year death and dependence after intracerebral hemorrhage, independent of known predictors of outcome. ANN NEUROL 2021;89:266–279