Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

Al-Shahi Salman R, Frantzias J, Lee RJ, Battey TW, Ayres AM, Goldstein JN, Mayer SA, Steiner T, Wang X, Arima H, Hasegawa H, Oishi M, Godoy DA, Masotti L, Dowlatshahi D, Rodriguez-Luna D, Molina CA, Jang DK, Davalos A, Castillo J, Yao X, Claassen J, Volbers B, Kazui S, Okada Y, Fujimoto S, Toyoda K, Li Q, Khoury J, Delgado P, Sabín JÁ, Hernández-Guillamon M, Prats-Sánchez L, Cai C, Kate MP, McCourt R, Venkatasubramanian C, Diringer MN, Ikeda Y, Worthmann H, Ziai WC, d'Esterre CD, Aviv RI, Raab P, Murai Y, Zazulia AR, Butcher KS, Seyedsaadat SM, Grotta JC, Martí-Fàbregas J, Montaner J, Broderick J, Yamamoto H, Staykov D, Connolly ES, Selim M, Leira R, Moon BH, Demchuk AM, Di Napoli M, Fujii Y, Anderson CS, Rosand J, Hanley DF, Davis S, Gregson B, Lees KR, Lyden PD, Muir KW, Xie P, Bakhshayesh B, McDonald M, Brott T, Pennati P, Parry-Jones AR, Smith CJ, Hopkins SJ, Slevin M, Campi V, Singh P, Papa F, Popa-Wagner A, Tudorica V, Takagi R, Teramoto A, Weissenborn K, Lanfermann H (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Book Volume: 17

Pages Range: 885-894

Journal Issue: 10

DOI: 10.1016/S1474-4422(18)30253-9

Abstract

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.

Authors with CRIS profile

Involved external institutions

University of New South Wales (UNSW) Australia (AU) Azienda Sanitaria di Firenze Italy (IT) Catholic University of Korea Korea, Republic of (KR) Hospital Internazonal General de Agudos Dr. Jose Penna Argentina (AR) Massachusetts General Hospital United States (USA) (US) Niigata University / 新潟大学 Japan (JP) King's College Hospital (KCH) United Kingdom (GB) University of Edinburgh United Kingdom (GB) Henry Ford Health System (HFHS) United States (USA) (US) University of Alberta Canada (CA) Columbia University Irving Medical Center (CUIMC) United States (USA) (US) National Cerebral and Cardiovascular Center Japan (JP) Washington University in St. Louis United States (USA) (US) National Hospital Organization Kyushu Medical Center Japan (JP) University of Cincinnati Medical Center (UCMC) / University of Cincinnati Academic Health Center United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Tokyo Medical University (TMU) / 東京医科大学 Japan (JP) Beth Israel Deaconess Medical Center (BIDMC) United States (USA) (US) Complejo Hospitalario Universitario de Santiago de Compostela Spain (ES) University of Calgary Canada (CA) Autonomous University of Barcelona (UAB) / Universitat Autònoma de Barcelona Spain (ES) Ottawa Hospital Research Institute Canada (CA) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Memorial Hermann United States (USA) (US) Stanford University United States (USA) (US) Mayo Clinic United States (USA) (US) Jichi Medical University / 自治医科大学 Japan (JP) University of Texas Health Science Center at Houston (UTHealth) United States (USA) (US) Hospital de la Santa Creu i Sant Pau Spain (ES) Renji Hospital / 仁济医院 / Rénjì Yīyuàn China (CN) Johns Hopkins University (JHU) United States (USA) (US) University of Toronto Canada (CA) Chongqing Medical University China (CN) Nippon Medical School Japan (JP)

How to cite

APA:

Al-Shahi Salman, R., Frantzias, J., Lee, R.J., Battey, T.W., Ayres, A.M., Goldstein, J.N.,... Lanfermann, H. (2018). Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurology, 17(10), 885-894. https://doi.org/10.1016/S1474-4422(18)30253-9

MLA:

Al-Shahi Salman, Rustam, et al. "Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data." Lancet Neurology 17.10 (2018): 885-894.

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