Rate of hematoma expansion as a predictor of outcome in intracerebral hemorrhage

Abstract

Objective: We examined the association between intracerebral hemorrhage hematoma expansion rate and 90-day outcomes using the Qatar Stroke Registry.

Methods: We conducted a retrospective analysis of patients admitted with supratentorial intracerebral hemorrhage from January 2014 to December 2024. The modified Rankin Scale was dichotomized into favourable (0–3) and unfavourable outcomes (4–6).

Results: A total of 1,351 patients were included in the final analysis. Fast volume-expanders (>10 mL/hr) had the highest mRS (p=0.002) and highest proportion of mortality at 90 days, compared to the slow volume expander (<5 mL/hr) and intermediate volume expander (5–10 mL/hr), p=0.01. Multivariate analysis revealed that severe NIHSS admission score (>10) was an independent predictor of mortality at 90 days (aOR 11.4, 95% CI: 4.58–28.5). Fast hematoma expansion rate was marginally associated with mortality at 90 days (aOR: 1.79, 95% CI: 0.99–3.20). In contrast, age (aOR 1.03, 95% CI: 1.02–1.04, p<.001), moderate stroke (aOR 3.21, 95% CI: 1.79–5.75, p<.001), severe stroke (aOR 27.0, 95% CI: 15.9–45.9, p<.001), and fast hematoma expansion rate (aOR 1.77, 95% CI: 1.10–2.85, p=0.02) were identified as predictors of a poor outcome (mRS of 4-6) at 90 days.

Conclusion: Fast hematoma expansion is independently associated with worse 90-day outcomes in the Arab population. In resource-limited settings where access to computed tomography angiography might be limited, using a CT head to calculate the volume expansion rate could be a useful predictor of outcomes in patients with supratentorial ICH.