02626nas a2200361   4500000000100000008004100001260001600042100001900058700001300077700001200090700001500102700001300117700001000130700001900140700001000159700001600169700001000185700001500195700001100210700001300221700001100234700001300245700001200258700001300270700001900283700001600302245009400318250001500412300001100427490000700438520177300445020004602218       2009                            d  c656976167991 aArima Hisatomi1 aLi Qiang1 aWang J.1 aParsons M.1 aCheng Y.1 aXu E.1 aMorgenstern L.1 aSu S.1 aHeeley Emma1 aLi Y.1 aSkulina C.1 aTao Q.1 aJiang J.1 aTai L.1 aZhang J.1 aPeng B.1 aHuang Y.1 aAnderson Craig1 aChalmers J.00aSignificance of perihematomal edema in acute intracerebral hemorrhage: the INTERACT trial  a2009/12/10  a1963-80 v733 a<p>
BACKGROUND: Uncertainty surrounds the effects of cerebral edema on outcomes in intracerebral hemorrhage (ICH). METHODS: We used data from the INTERACT trial to determine the predictors and prognostic significance of "perihematomal" edema over 72 hours after ICH. INTERACT included 404 patients with CT-confirmed ICH and elevated systolic blood pressure (BP) (150-220 mm Hg) who had the capacity to commence BP lowering treatment within 6 hours of ICH. Baseline and repeat CT (24 and 72 hours) were performed using standardized techniques, with digital images analyzed centrally. Predictors of growth in edema were determined using generalized estimating equations, and its effects on clinical outcomes were estimated using a logistic regression model. RESULTS: Overall, 270 patients had 3 sequential CT scans available for analyses. At baseline, there was a highly significant correlation between hematoma and perihematomal edema volumes (r(2) = 0.45). Lower systolic BP and baseline hematoma volume were independently associated with absolute increase in perihematomal edema volume. History of hypertension, baseline hematoma volume, and earlier time from onset to CT were independently associated with relative increase in edema volume. Both absolute and relative increases in perihematomal edema growth were significantly associated with death or dependency at 90 days after adjustment for age, gender, and randomized treatment, but not when additionally adjusted for baseline hematoma volume. CONCLUSIONS: The degree of, and growth in, perihematomal edema are strongly related to the size of the underlying hematoma of acute intracerebral hemorrhage, and do not appear to have a major independent effect in determining the outcome from this condition.
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