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Added Value of Frequency of Imaging Markers for Prediction of Outcome After Intracerebral Hemorrhage: A Secondary Analysis of Existing Data

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Abstract

Background

Frequency of imaging markers (FIM) has been identified as an independent predictor of hematoma expansion in patients with intracerebral hemorrhage (ICH), but its impact on clinical outcome of ICH is yet to be determined. The aim of the present study was to investigate this association.

Methods

This study was a secondary analysis of our prior research. The data for this study were derived from six retrospective cohorts of ICH from January 2018 to August 2022. All consecutive study participants were examined within 6 h of stroke onset on neuroimaging. FIM was defined as the ratio of the number of imaging markers on noncontrast head tomography (i.e., hypodensities, blend sign, and island sign) to onset-to-neuroimaging time. The primary poor outcome was defined as a modified Rankin Scale score of 3–6 at 3 months.

Results

A total of 1253 patients with ICH were included for final analysis. Among those with available follow-up results, 713 (56.90%) exhibited a poor neurologic outcome at 3 months. In a univariate analysis, FIM was associated with poor prognosis (odds ratio 4.36; 95% confidence interval 3.31–5.74; p < 0.001). After adjustment for age, Glasgow Coma Scale score, systolic blood pressure, hematoma volume, and intraventricular hemorrhage, FIM was still an independent predictor of worse prognosis (odds ratio 3.26; 95% confidence interval 2.37–4.48; p < 0.001). Based on receiver operating characteristic curve analysis, a cutoff value of 0.28 for FIM was associated with 0.69 sensitivity, 0.66 specificity, 0.73 positive predictive value, 0.62 negative predictive value, and 0.71 area under the curve for the diagnosis of poor outcome.

Conclusions

The metric of FIM is associated with 3-month poor outcome after ICH. The novel indicator that helps identify patients who are likely within the 6-h time window at risk for worse outcome would be a valuable addition to the clinical management of ICH.

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Acknowledgements

Thanks to all the coworkers who made a contribution to this research and to all the patients who made this research possible.

Funding

This study was supported by the Hubei Provincial Natural Science Foundation Innovation and Development Joint Fund (Grant No. 2023AFD016).

Author information

Author notes

  1. Lianghong Kuang and Shinuan Fei have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China

    Lianghong Kuang

  2. Department of Pediatrics, Huangshi Maternity and Children’s Health Hospital, Affiliated Maternity and Children’s Health Hospital of Hubei Polytechnic University, Huangshi, China

    Shinuan Fei

  3. Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China

    Hang Zhou

  4. Postgraduate Joint Training Base of Huangshi Central Hospital, Wuhan University of Science and Technology, Huangshi, China

    Le Huang & Cailian Guo

  5. Computer School, Hubei Polytechnic University, Huangshi, China

    Jun Cheng

  6. Department of Radiology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China

    Wenmin Guo

  7. Department of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, No. 141, Tianjin Road, Huangshigang District, Huangshi, 435000, China

    Yu Ye, Hui Xiong, Xiaoming Qiu & Lei Song

  8. Department of Radiology, Tangshan Gongren Hospital, Tangshan, China

    Rujia Wang

  9. Department of Clinical Laboratory, Xiangyang Central Haspital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China

    Ji Zhang

  10. Department of Neurosurgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China

    Dongfang Tang

  11. Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China

    Liwei Zou

  12. Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China

    Yongqiang Yu

Authors
  1. Lianghong Kuang
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  2. Shinuan Fei
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  6. Jun Cheng
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  7. Wenmin Guo
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  8. Yu Ye
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  9. Rujia Wang
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  11. Ji Zhang
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  12. Dongfang Tang
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  13. Liwei Zou
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  15. Yongqiang Yu
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  16. Lei Song
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Contributions

LK and SF: manuscript writing and interpretation of data; HZ, WG, Y. Ye, RW, JZ, HX, DT, LZ: data collection; Y. Yu and XQ: study design, manuscript review; JC, LH, and CG: data analysis; LS: study design and supervision.

Corresponding author

Correspondence to Lei Song.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Clinical trial registration

Clinical registration Retrospectively registered upon approval of the local Institutional Review Board.

Human and Animal Rights

All included human research has been approved by the appropriate institutional review boards and/or ethics committees as appropriate.

Ethical Approval/Informed Consent

Because of the absence of any individually identifying information in the data set, the local institutional review board granted an exemption to informed consent (IRB no. 2022-22, 2021-036, XYYYE20220081, PJ2022-09-30, YX2023-134, and GRYY-LL-KJ2022-K820).

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Kuang, L., Fei, S., Zhou, H. et al. Added Value of Frequency of Imaging Markers for Prediction of Outcome After Intracerebral Hemorrhage: A Secondary Analysis of Existing Data. Neurocrit Care (2024). https://doi.org/10.1007/s12028-024-01963-x

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