Noncontrast Computed Tomography Signs as Predictors of Hematoma Expansion, Clinical Outcome and Response to Tranexamic Acid in Acute Intracerebral Hemorrhage

Law, Zhe Kang; Ali, Azlinawati; Krishnan, Kailash; Bischoff, Adam; Appleton, Jason; Scutt, Polly; Woodhouse, Lisa; Pszczolkowski, Stefan; Cala, Lesley; Dineen, Robert; England, Timothy; Ozturk, Serefnur; Roffe, Christine; Bereczki, D�niel; Ciccone, Alfonso; Christensen, Hanne; Ovesen, Christian; Bath, Philip; Sprigg, Nikola

Abstract

Background and purpose

Blend, black hole and island signs and hypodensities are reported to predict hematoma expansion in acute intracerebral hemorrhage (ICH). We explored the value of these noncontrast CT (NCCT) signs in predicting hematoma expansion and functional outcome in our cohort of ICH.

Methods

The Tranexamic acid for IntraCerebral Hemorrhage-2 (TICH-2) was a prospective randomized controlled trial exploring the efficacy and safety of tranexamic acid in acute ICH. Baseline and 24-hour CT scans of patients recruited into the trial were analysed. Hematoma expansion was defined as an increase in hematoma volume of >33% or > 6 mL on 24-hour CT. Poor functional outcome was defined as modified Rankin Scale of 4 to 6 at day 90. Multivariable logistic regression was performed to identify predictors of hematoma expansion and poor functional outcome.

Results

Of 2325 patients recruited, 2077 (89.3%) had valid baseline and 24-hour scans. 570 patients (27.4%) had hematoma expansion while 1259 patients (54.6%) had poor functional outcome. The prevalence of NCCT signs was: blend sign-366 (16.1%); black hole sign-414 (18.2%); island sign-200 (8.8%); and hypodensities-701 (30.2%). Blend sign (adjusted odds ratio [aOR] 1.53, 95% CI 1.16-2.03; P=0.003), black hole (aOR 2.03, 1.34-3.08; P=0.001) and hypodensities (aOR 2.06, 1.48-2.89; P0.05).

Conclusions

Blend sign, black hole sign and hypodensities predict hematoma expansion while black hole sign, hypodensities and island signs predict poor functional outcome. NCCT signs did not predict a better response to tranexamic acid.

Citation

Law, Z. K., Ali, A., Krishnan, K., Bischoff, A., Appleton, J., Scutt, P., Woodhouse, L., Pszczolkowski, S., Cala, L., Dineen, R., England, T., Ozturk, S., Roffe, C., Bereczki, D., Ciccone, A., Christensen, H., Ovesen, C., Bath, P., & Sprigg, N. (2020). Noncontrast Computed Tomography Signs as Predictors of Hematoma Expansion, Clinical Outcome and Response to Tranexamic Acid in Acute Intracerebral Hemorrhage. Stroke, 51(1), 121–128. https://doi.org/10.1161/STROKEAHA.119.026128

• Journal Article Type: Article
• Acceptance Date: Sep 20, 2019
• Online Publication Date: Nov 18, 2019
• Publication Date: 2020-01
• Deposit Date: Oct 11, 2019
• Publicly Available Date: May 19, 2020
• Journal: Stroke
• Print ISSN: 0039-2499
• Electronic ISSN: 1524-4628
• Publisher: American Heart Association
• Peer Reviewed: Peer Reviewed
• Volume: 51
• Issue: 1
• Pages: 121–128
• DOI: https://doi.org/10.1161/STROKEAHA.119.026128
• Keywords: Advanced and Specialised Nursing; Clinical Neurology; Cardiology and Cardiovascular Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/2805606
• Publisher URL: https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.026128
• Contract Date: Oct 11, 2019