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Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage

Isabel C Hostettler1, Ghil Schwarz1, Gareth Ambler1

  • 1From the Stroke Research Centre (I.C.H., G.S., D.W., G.B., D.J.S., C.S., S.L., M.M.B., D.J.W.), University College London, Queen Square Institute of Neurology; Department of Neurology (G.S.), Stroke Unit, San Raffaele Hospital, Milan, Italy; Department of Statistical Science (G.A.), University College London, Gower Street, UK; Department of Neurology and Stroke Center (D.J.S.), Inselspital, Bern, Switzerland; Haemostasis Research Unit (H.C.), Department of Haematology, University College London, Chenies Mews; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.A.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), Liverpool Heart and Chest Hospital, University of Liverpool; Institute of Neuroscience & Psychology (K.W.M.), University of Glasgow, Queen Elizabeth University Hospital, Glasgow; and Department of Molecular Neuroscience (H.H.), UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London.

Neurology
|February 25, 2021
PubMed

Insights

Cerebral small vessel disease (SVD) biomarkers on CT scans are linked to poor functional outcomes after intracerebral hemorrhage (ICH). However, these SVD markers do not significantly enhance the predictive accuracy of the existing ICH score.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Intracerebral hemorrhage (ICH) is a severe neurological condition with significant disability.
  • Predicting functional outcome after ICH is crucial for patient management and resource allocation.
  • Cerebral small vessel disease (SVD) is a common comorbidity in patients with ICH.

Purpose of the Study:

  • To investigate the association between CT-derived SVD biomarkers and 6-month functional outcomes following ICH.
  • To determine if SVD biomarkers can improve the predictive performance of the established ICH score.

Main Methods:

  • A prospective cohort study included 864 patients with acute ICH.
  • CT scans were analyzed for SVD biomarkers: white matter hypodensities (WMH), lacunes, and brain atrophy.
  • Functional outcome was assessed using the modified Rankin Scale (mRS) at 6 months.
  • The predictive ability of the ICH score was evaluated with and without SVD biomarkers using AUROC and Hosmer-Lemeshow tests.

Main Results:

  • WMH, cortical atrophy, deep atrophy, and severe atrophy were independently associated with poor 6-month functional outcome (mRS > 2).
  • The original ICH score demonstrated acceptable discrimination (AUROC 0.71).
  • Adding SVD biomarkers to the ICH score did not significantly improve its predictive discrimination, with the best model achieving an AUROC of 0.73.

Conclusions:

  • CT-based SVD biomarkers are significantly associated with functional outcomes after ICH.
  • While SVD markers provide prognostic information, they do not substantially enhance the predictive accuracy of the current ICH score for functional outcomes.
Abstract

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