TY  - JOUR
A1  - Al-Shahi Salman, Rustam
A1  - Frantzias, Joseph
A1  - Lee, Robert J.
A1  - Lyden, Patrick D.
A1  - Battey, Thomas W. K.
A1  - Ayres, Alison M.
A1  - Goldstein, Joshua Norkin
A1  - Mayer, Stephan A.
A1  - Steiner, Thorsten
A1  - Wang, Xia
A1  - Arima, Hisatomi
A1  - Hasegawa, Hitoshi
A1  - Oishi, Makoto
A1  - Godoy, Daniel Agustín
A1  - Masotti, Luca
A1  - Dowlatshahi, Dar
A1  - Rodríguez-Luna, David
A1  - Molina, Carlos
A1  - Jang, Dong-Kyu
A1  - Davalos, Antonio
A1  - Castillo, José
A1  - Yao, Xiaoying
A1  - Claassen, Jan
A1  - Volbers, Bastian
A1  - Kazui, Seiji
A1  - Okada, Yasushi
A1  - Fujimoto, Shigeru
A1  - Toyoda, Kazunori
A1  - Li, Qi
A1  - Khoury, Jane
A1  - Delgado, Pilar
A1  - Álvarez-Sabín, José
A1  - Hernández-Guillamon, Mar
A1  - Prats-Sánchez, Luis
A1  - Cai, Chunyan
A1  - Kate, Mahesh
A1  - McCourt, Rebecca
A1  - Venkatasubramanian, Chitra
A1  - Diringer, Michael N.
A1  - Ikeda, Yukio
A1  - Worthmann, Hans
A1  - Ziai, Wendy C.
A1  - D’Esterre, Christopher D.
A1  - Aviv, Richard I.
A1  - Raab, Peter
A1  - Murai, Yasuo
A1  - Zazulia, Allyson R.
A1  - Butcher, Kenneth
A1  - Seyedsaadat, Seyed Mohammad
A1  - Grotta, James C.
A1  - Martí-Fàbregas, Joan
A1  - Montaner, Joan
A1  - Broderick, Joseph
A1  - Yamamoto, Haruko
A1  - Staykov, Dimitre
A1  - Connolly, Edward Sander
A1  - Selim, Magdy
A1  - Leira, Rogelio
A1  - Moon, Byung Hoo
A1  - Demchuk, Andrew M.
A1  - Di Napoli, Mario
A1  - Fujii, Yukihiko
A1  - Anderson, Craig S.
A1  - Rosand, Jonathan
T1  - Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage : a systematic review and meta-analysis of individual patient data
T2  - The lancet. Neurology
N2  - Background: Intracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography.
Methods: In a systematic review of OVID MEDLINE—with additional hand-searching of relevant studies' bibliographies— from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5–24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known.
Findings: Of 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56–76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36–0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46–11·60; p<0·0001), antiplatelet use (1·68, 1·06–2·66; p=0·026), and anticoagulant use (3·48, 1·96–6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75–0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95–6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03–0·07).
Interpretation: In this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects in prior randomised trials, and guide the design of future trials.
Funding: UK Medical Research Council and British Heart Foundation.
Y1  - 2018
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/46402
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-464024
SN  - 1474-4465
SN  - 1474-4422
N1  - Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
N1  - Correction erschienen in: The lancet. Neurology, 17.2018, Nr. 11, S. 933, doi:10.1016/S1474-4422(18)30354-5
VL  - 17
IS  - 10
SP  - 885
EP  - 894
PB  - Lancet Publ. Group
CY  - London
ER  -