Predicting Intracerebral Hemorrhage Outcomes With Peak Perihemorrhagic Edema

brain hemorrhage
brain hemorrhage
Further research may be necessary to better understand the pathophysiologic mechanisms involved in perihemorrhagic edema evolution and ICH.

Peak perihemorrhagic edema (PHE) volume is an independent predictor of 90-day functional outcome following an intracerebral hemorrhage (ICH), with each additional milliliter of PHE volume being associated with an increased 1.5% risk for poor outcome, according to findings from a retrospective study published in Neurology.

Patients in whom spontaneous supratentorial ICH developed between 2006 and 2014 were included in this retrospective analysis (n=292). Investigators assessed ICH and PHE volumes and used multivariable logistic regression and propensity score matching analyses to examine these measures and their association with functional outcome up to 90 days. A modified Rankin Scale of 0 to 3 and 4 to 6 represented favorable and poor outcomes, respectively.

The median ICH volume was 17.7 mL (interquartile range [IQR] 7.9-40.2) at time of hospital admission, whereas the median peak ICH volume was 22.5 mL (IQR 8.9-46.4). In addition, the baseline median PHE volume on admission was 16.3 mL (IQR 9.1-29.2), which increased to a median peak volume of 37.5 mL (IQR 19.0-60.6) over approximately 7 days (IQR 3-12).

According to multivariable logistic regression analysis, the peak PHE volume was deemed an independent predictor for 90-day functional outcome (odds ratio [OR] 0.984 for each mL of PHE; 95% CI, 0.973-0.994). In addition, the peak PHE volume was associated with the initial PHE increase up to 3 days following admission (OR 1.060; 95% CI, 1.018-1.103) and was independently associated with the neutrophil to lymphocyte ratio on day 6 (OR 1.236; 95% CI, 1.034-1.477; propensity score matching cohort, n=124). In addition, the investigators found that there was an independent association between the initial PHE increase and fever burden on days 2 to 3 (OR 1.456; 95% CI, 1.103-1.920) as well as hematoma expansion (OR 3.647; 95% CI, 1.533-8.679).

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This study included patients who were admitted to a single center, which limits the findings to this 1 patient group. There was also substantial variation between individuals with regard to length of hospital stay and number of computed tomography scans performed, which may have resulted in inaccurate measurements of actual peak PHE volumes.

Because of the study’s retrospective design and small number of participants, further research may be necessary “to shed light into the pathophysiologic mechanisms that act beyond perihemorrhagic edema evolution and to open up avenues for potential treatment targets in patients with ICH.”


Volbers B, Giede-Jeppe A, Gerner ST, et al. Peak perihemorrhagic edema correlates with functional outcome in intracerebral hemorrhage. Neurology. 2018;90(12):e1005-e1012.