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

Abstract

Abstract Background: Frequency of imaging markers (FIM) has been identified as an independent predictor of hematoma expansion (HE) 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. FIM was defined as the ratio of the number of imaging markers (i.e., hypodensities, blend sign, and island sign) to onset-to-neuroimaging time. Poor outcome was defined as modified Rankin Scale of 3–6 at 3 months. Results: 1,253 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 outcome (odds ratio [OR] = 4.36; 95% confidence interval [CI] = 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 (OR = 3.26; 95% CI = 2.37–4.48; p < 0.001). Based on receiver operating characteristic curve analysis, a cut-off value of 0.28 for FIM was associated with 0.68 sensitivity, 0.69 specificity, 0.74 positive predictive value, 0.62 negative predictive value, and 0.72 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 marker that helps identify patients at risk for worse outcome would be a valuable addition to the clinical management of ICH.