Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage.

Hostettler, Isabel C; Schwarz, Ghil; Ambler, Gareth; Wilson, Duncan; Banerjee, Gargi; Seiffge, David J; Shakeshaft, Clare; Lunawat, Surabhika; Cohen, Hannah; Yousry, Tarek A; Al-Shahi Salman, Rustam; Lip, Gregory Y H; Brown, Martin M; Muir, Keith W; Houlden, Henry; Jäger, Hans Rolf; Werring, David J (2021). Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage. Neurology, 96(15), e1954-e1965. American Academy of Neurology 10.1212/WNL.0000000000011746

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OBJECTIVE

To determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH) and whether these biomarkers improve the performance of the preexisting ICH prediction score.

METHODS

We included 864 patients with acute ICH from a multicenter, hospital-based prospective cohort study. We evaluated CT-based SVD biomarkers (white matter hypodensities [WMH], lacunes, brain atrophy, and a composite SVD burden score) and their associations with poor 6-month functional outcome (modified Rankin Scale score >2). The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow test were used to assess discrimination and calibration of the ICH score with and without SVD biomarkers.

RESULTS

In multivariable models (adjusted for ICH score components), WMH presence (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.12-2.06), cortical atrophy presence (OR 1.80, 95% CI 1.19-2.73), deep atrophy presence (OR 1.66, 95% CI 1.17-2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95% CI 1.36-2.74) were independently associated with poor functional outcome. For the revised ICH score, the AUROC was 0.71 (95% CI 0.68-0.74). Adding SVD markers did not significantly improve ICH score discrimination; for the best model (adding severe atrophy), the AUROC was 0.73 (95% CI 0.69-0.76). These results were confirmed when lobar and nonlobar ICH were considered separately.

CONCLUSIONS

The ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome, but adding them does not significantly improve ICH score discrimination.

TRIAL REGISTRATION INFORMATION

ClinicalTrials.gov Identifier: NCT02513316.

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