Early Increase in Perihematomal Edema Volume after Intracerebral Hemorrhage Is an Independent Predictor of 90-Day Poor Functional Outcome.

Abstract

To investigate the association between the increase in perihematomal edema (PHE) volume within 72 hours after intracerebral hemorrhage (ICH) and 90-day poor functional outcome. This retrospective cohort study consecutively enrolled patients with acute primary ICH admitted to a stroke center. All patients underwent CT scans at 6 hours and 72 hours after admission. Poor functional outcome at 90 days (modified Rankin Scale [mRS] 3-6) was used as the endpoint to evaluate the predictive value of hematoma volume, PHE volume, and their dynamic changes. A total of 81 patients were included, of whom 49 (61%) had poor outcomes (mRS 3-6). Compared to the good-outcome group, the poor-outcome group had older age, higher NIHSS scores, larger baseline and follow-up intraparenchymal hemorrhage (IPH) volumes, larger baseline and follow-up PHE volumes, and greater increases in IPH and PHE volumes. ROC curve analysis demonstrated that the increase in PHE volume had the highest predictive accuracy for 90-day poor outcome (AUC = 0.842, 95% CI: 0.758-0.927), significantly outperforming baseline hematoma volume, follow-up hematoma volume, and other conventional imaging indicators. Multivariate logistic regression confirmed that early PHE volume increase was an independent predictor of 90-day poor outcome (adjusted OR = 3.83, 95% CI: 1.21-12.74). The increase in PHE volume within 72 hours after ICH is an independent predictor of poor early prognosis, with superior predictive value compared to traditional imaging markers. It may serve as a critical reference for early risk stratification and treatment decision-making in ICH patients.