Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data
Por:
Al-Shahi Salman R., Frantzias J., Lee R.J., Battey T.W.K., Ayres A.M., Goldstein J.N., Mayer S.A., Steiner T., Wang X., Arima H., Hasegawa H., Oishi M., Godoy D.A., Masotti L., Dowlatshahi D., Rodriguez-Luna D., Molina C.A., Jang D.-K., Davalos A., Castillo J., Yao X., Claassen J., Volbers B., Kazui S., Okada Y., Fujimoto S., Toyoda K., Li Q., Khoury J., Delgado P., SabÃn J.Ã., Hernández-Guillamon M., Prats-Sánchez L., Cai C., Kate M.P., McCourt R., Venkatasubramanian C., Diringer M.N., Ikeda Y., Worthmann H., Ziai W.C., d'Esterre C.D., Aviv R.I., Raab P., Murai Y., Zazulia A.R., Butcher K.S., Seyedsaadat S.M., Grotta J.C., MartÃ-Fà bregas J., Montaner J., Broderick J., Yamamoto H., Staykov D., Connolly E.S., Selim M., Leira R., Moon B.H., Demchuk A.M., Di Napoli M., Fujii Y., Anderson C.S., Rosand J., Hanley D.F., Jr, Davis S., Gregson B., Lees K.R., Lyden P.D., Muir K.W., Xie P., Bakhshayesh B., McDonald M., Brott T., Pennati P., Parry-Jones A.R., Smith C.J., Hopkins S.J., Slevin M., Campi V., Singh P., Papa F., Popa-Wagner A., Tudorica V., Takagi R., Teramoto A., Weissenborn K., Lanfermann H.
Publicada:
1 ene 2018
Resumen:
Background: Intracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography. Methods: In a systematic review of OVID MEDLINE—with additional hand-searching of relevant studies' bibliographies— from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5–24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known. Findings: Of 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56–76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36–0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46–11·60; p<0·0001), antiplatelet use (1·68, 1·06–2·66; p=0·026), and anticoagulant use (3·48, 1·96–6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75–0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95–6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03–0·07). Interpretation: In this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects in prior randomised trials, and guide the design of future trials. Funding: UK Medical Research Council and British Heart Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Filiaciones:
Al-Shahi Salman R.:
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
Frantzias J.:
Department of Neurosurgery, King's College Hospital, London, United Kingdom
Lee R.J.:
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
Battey T.W.K.:
Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
Ayres A.M.:
Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
Goldstein J.N.:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
Mayer S.A.:
Department of Neurology, Henry Ford Health System, Detroit, MI, United States
Steiner T.:
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
Wang X.:
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Arima H.:
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Hasegawa H.:
Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
Oishi M.:
Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
Godoy D.A.:
Intensive Care Unit, Hospital Interzonal de Agudos “San Juan Bautistaâ€, Catamarca, Argentina
Masotti L.:
Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy
Dowlatshahi D.:
Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
Rodriguez-Luna D.:
Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
Molina C.A.:
Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
Jang D.-K.:
Department of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
Davalos A.:
Department of Neurosciences, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain
Castillo J.:
Department of Neurology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
Yao X.:
Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Claassen J.:
Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY, United States
Volbers B.:
Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Kazui S.:
Kazui Medical Office, Ikeda, Osaka, Japan
Okada Y.:
Department of Cerebrovascular Medicine and Neurology, National Hospital Organisation Kyushu Medical Centre, Fukuoka, Japan
Fujimoto S.:
Division of Neurology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
Toyoda K.:
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Li Q.:
Department of Neurology, ThE First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Khoury J.:
University of Cincinnati Medical Centre, Cincinnati, OH, United States
Delgado P.:
Neurovascular Research Lab, Neurovascular Section, Institut de Recerca and Hospital Vall d'Hebron, Barcelona, Spain
SabÃn J.Ã.:
Neurovascular Research Lab, Neurovascular Section, Institut de Recerca and Hospital Vall d'Hebron, Barcelona, Spain
Hernández-Guillamon M.:
Neurovascular Research Lab, Neurovascular Section, Institut de Recerca and Hospital Vall d'Hebron, Barcelona, Spain
Prats-Sánchez L.:
Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
Cai C.:
Centre for Clinical and Translational Sciences, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, United States
Kate M.P.:
Department of Neurology, University of Alberta, Edmonton, AB, Canada
McCourt R.:
Department of Neurology, University of Alberta, Edmonton, AB, Canada
Venkatasubramanian C.:
Division of Stroke and Neurocritical Care, Stanford University, Palo Alto, CA, United States
Diringer M.N.:
Department of Neurology and Neurological Surgery, Washington University, St Louis, MO, United States
Ikeda Y.:
Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
Worthmann H.:
Department of Neurology, Hannover Medical School, Hannover, Germany
Ziai W.C.:
Johns Hopkins University School of Medicine, Department of Neurology, Anaesthesia and Critical Care Medicine, Division of Neurocritical Care, Baltimore, MD, United States
d'Esterre C.D.:
Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
Aviv R.I.:
Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
Raab P.:
Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
Murai Y.:
Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
Zazulia A.R.:
Department of Neurology and Neurological Surgery, Washington University, St Louis, MO, United States
Butcher K.S.:
Department of Neurology, University of Alberta, Edmonton, AB, Canada
Seyedsaadat S.M.:
Department of Radiology, Mayo Clinic, Rochester, MN, United States
Grotta J.C.:
Memorial Hermann Hospital, Clinical Innovation and Research Institute, Houston, TX, United States
MartÃ-FÃ bregas J.:
Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
Montaner J.:
Neurovascular Research Lab, Neurovascular Section, Institut de Recerca and Hospital Vall d'Hebron, Barcelona, Spain
Broderick J.:
University of Cincinnati Medical Centre, Cincinnati, OH, United States
Yamamoto H.:
Center for Advanced Clinical and Translational Sciences, National Cerebral and Cerebrovascular Center, Suita, Osaka, Japan
Staykov D.:
Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
Department of Neurology, Hospital of the Brothers of St John, Eisenstadt, Austria
Connolly E.S.:
Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York, NY, United States
Selim M.:
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
Leira R.:
Department of Neurology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
Moon B.H.:
Department of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
Demchuk A.M.:
Department of Clinical Neurosciences and Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Di Napoli M.:
Neurological Service, San Camillo de'Lellis General Hospital, Rieti, Italy
Fujii Y.:
Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
Anderson C.S.:
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
The George Institute for Global Health, China at Peking University Health Science Center, Beijing, China
Rosand J.:
Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
Lyden P.D.:
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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