White matter lesions and poor outcome after intracerebral hemorrhage A nationwide cohort study

• Published in: Neurology
• Main Authors: Lee, S. -H., Kim, B. J., Ryu, W. -S., Kim, C. K., Park, B. -J., Yoon, B. -W., Kim, N.
• Format: Article in Journal/Newspaper
• Language: English
• Published: LIPPINCOTT WILLIAMS & WILKINS 2010
• Subjects: Barton; Greenland; Hemphill; Jama; Meredith
• Online Access: http://hdl.handle.net/10371/77426; https://doi.org/10.1212/WNL.0b013e3181dd425a

Background: The ability to predict poor outcome is important for patient care and treatment decision-making in cases of intracerebral hemorrhage (ICH). Previous studies have included relatively brief follow-up periods and small numbers of patients, and are limited in terms of considerations regarding individual brain vulnerabilities. Methods: The authors prospectively enrolled 1,321 ICH patients nationwide from 33 hospitals. Clinical, laboratory, and imaging variables, including white matter lesions (WMLs), were collected at admission. Immediate outcome after ICH was measured using total Glasgow Coma Scale (GCS) score at admission, early outcome using 30-day mortality, and long-term outcome using relative risk for mortality. The vital status of included patients was ascertained on December 31, 2006, using Korean National Death Certificates (mean follow-up, 32.6 months). Results: Of the 1,321 ICH patients included, 352 (27.8%) presented with a moderate GCS score (8.5-12.4) and 249 (19.7%) with a severe GCS score (<= 8.4). The mortality rate was 9.1% at day 30 post-ICH and 381 patients (29.8%) had died up to the end of December 2006. Extensive WMLs were associated with severe GCS scores at admission (odds ratio [OR] 2.45, 95% confidence interval [Cl] 1.73-3.46), 30-day mortality (OR 2.52, 95% Cl 1.33-4.75), and the relative risk for mortality (RR 2.61, 95% Cl 1.79-3.82) after adjusting for relevant covariates. Conclusions: These findings suggest that white matter lesions, which may reflect the vulnerability of individual brains to pathologic insults, should be considered when assessing immediate, early, and long-term outcomes after intracerebral hemorrhage. Lee SH, 2010, DIABETOLOGIA, V53, P429, DOI 10.1007/s00125-009-1617-z Rost NS, 2008, STROKE, V39, P2304, DOI 10.1161/STROKEAHA.107.512202 Barton CW, 2007, ACAD EMERG MED, V14, P695, DOI 10.1197/j.aem.2007.03.1358 Zahuranec DB, 2007, NEUROLOGY, V68, P1651 Ruiz-Sandoval JL, 2007, STROKE, V38, P1641, DOI 10.1161/STROKEAHA.106.478222 Palumbo V, 2007, NEUROLOGY, V68, P1020 Yoon BW, 2007, NEUROLOGY, V68, P146, DOI 10.1212/01.wnl.0000250351.38999.f2 Flaherty ML, 2006, NEUROLOGY, V66, P1182 Ovbiagele B, 2006, CEREBROVASC DIS, V22, P83, DOI 10.1159/000093235 KALARIA RN, 2006, J CLIN NEUROL, V2, P1 Ariesen MJ, 2005, J NEUROL NEUROSUR PS, V76, P839, DOI 10.1136/jnnp.2004.048223 Roquer J, 2005, J NEUROL, V252, P412, DOI 10.1007/s00415-005-0659-5 GALLEGO J, 2005, CEREBROVASC DIS, V20, P1 Smith EE, 2004, NEUROLOGY, V63, P1606 Kidwell CS, 2004, JAMA-J AM MED ASSOC, V292, P1823 Greenland P, 2004, JAMA-J AM MED ASSOC, V291, P210 KASE CS, 2004, STROKE PATHOPHYSIOLO, P327 Inagawa T, 2003, NEUROSURGERY, V53, P1283, DOI 10.1227/01.NEU.0000093825.04365.F3 Cheung RTF, 2003, STROKE, V34, P1717, DOI 10.1161/01.STR.0000078657.22835.B9 Wardlaw JM, 2003, STROKE, V34, P806, DOI 10.1161/01.STR.0000058480.77236.B3 INAGAWA T, 2003, NEUROSURGERY, V53, P1297 Hemphill JC, 2001, STROKE, V32, P891 Briley DP, 2000, NEUROLOGY, V54, P90 Gorter JW, 1999, NEUROLOGY, V53, P1319 Broderick JP, 1999, STROKE, V30, P905 Leys D, 1999, EUR NEUROL, V42, P67 van Gijn J, 1998, NEUROLOGY, V51, pS3 Meredith W, 1998, J TRAUMA, V44, P839 MEREDITH W, 1998, J TRAUMA, V44, P844 Qureshi AI, 1997, STROKE, V28, P961 TATEMICHI TK, 1994, NEUROLOGY, V44, P1885 VANSWIETEN JC, 1992, ANN NEUROL, V32, P177 CAPLAN LR, 1992, LANCET, V339, P656 VANSWIETEN JC, 1990, J NEUROL NEUROSUR PS, V53, P1080 SCHUTZ H, 1990, STROKE, V21, P1412 PETERSON B, 1990, APPL STAT-J ROY ST C, V39, P205 SELEKLER K, 1989, STROKE, V20, P1016 FAZEKAS F, 1987, AM J ROENTGENOL, V149, P351 HACHINSKI VC, 1987, ARCH NEUROL-CHICAGO, V44, P21 BROTT T, 1986, STROKE, V17, P1078 MOHR JP, 1978, NEUROLOGY, V28, P754 8