TY - JOUR
T1 - Effect of Hyperosmolar Therapy on Outcome Following Spontaneous Intracerebral Hemorrhage
T2 - Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study
AU - Shah, Manan
AU - Birnbaum, Lee
AU - Rasmussen, Jennifer
AU - Sekar, Padmini
AU - Moomaw, Charles J.
AU - Osborne, Jennifer
AU - Vashkevich, Anastasia
AU - Woo, Daniel
N1 - Funding Information:
Grant support: This study is supported by a grant from the National Institute of Neurological Disorders and Stroke (NINDS: U-01-NS069763).
Publisher Copyright:
© 2018 National Stroke Association
PY - 2018/4
Y1 - 2018/4
N2 - Purpose: We aimed to identify the effect of hyperosmolar therapy (mannitol and hypertonic saline) on outcomes after intracerebral hemorrhage (ICH) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study. Methods: Comparison of ICH cases treated with hyperosmolar therapy versus untreated cases was performed using a propensity score based on age, initial Glasgow Coma Scale, location of ICH (lobar, deep, brainstem, and cerebellar), log-transformed initial ICH volume, presence of intraventricular hemorrhage, and surgical interventions. ERICH subjects with a pre-ICH modified Rankin Scale (mRS) score of 3 or lower were included. Treated cases were matched 1:1 to untreated cases by the closest propensity score (difference ≤.15), gender, and race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic). The McNemar and the Wilcoxon signed-rank tests were used to compare 3-month mRS outcomes between the 2 groups. Good outcome was defined as a 3-month mRS score of 3 or lower. Results: As of December 31, 2013, the ERICH study enrolled 2279 cases, of which 304 hyperosmolar-treated cases were matched to 304 untreated cases. Treated cases had worse outcome at 3 months compared with untreated cases (McNemar, P =.0326), and the mean 3-month mRS score was lower in the untreated group (Wilcoxon, P =.0174). Post hoc analysis revealed more brain edema, herniation, and death at discharge for treated cases. Conclusions: Hyperosmolar therapy was not associated with better 3-month mRS outcomes for ICH cases in the ERICH study. This finding likely resulted from greater hyperosmolar therapy use in patients with edema and herniation rather than those agents leading to worse outcomes. Further studies should be performed to determine if hyperosmolar agents are effective in preventing poor outcomes.
AB - Purpose: We aimed to identify the effect of hyperosmolar therapy (mannitol and hypertonic saline) on outcomes after intracerebral hemorrhage (ICH) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study. Methods: Comparison of ICH cases treated with hyperosmolar therapy versus untreated cases was performed using a propensity score based on age, initial Glasgow Coma Scale, location of ICH (lobar, deep, brainstem, and cerebellar), log-transformed initial ICH volume, presence of intraventricular hemorrhage, and surgical interventions. ERICH subjects with a pre-ICH modified Rankin Scale (mRS) score of 3 or lower were included. Treated cases were matched 1:1 to untreated cases by the closest propensity score (difference ≤.15), gender, and race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic). The McNemar and the Wilcoxon signed-rank tests were used to compare 3-month mRS outcomes between the 2 groups. Good outcome was defined as a 3-month mRS score of 3 or lower. Results: As of December 31, 2013, the ERICH study enrolled 2279 cases, of which 304 hyperosmolar-treated cases were matched to 304 untreated cases. Treated cases had worse outcome at 3 months compared with untreated cases (McNemar, P =.0326), and the mean 3-month mRS score was lower in the untreated group (Wilcoxon, P =.0174). Post hoc analysis revealed more brain edema, herniation, and death at discharge for treated cases. Conclusions: Hyperosmolar therapy was not associated with better 3-month mRS outcomes for ICH cases in the ERICH study. This finding likely resulted from greater hyperosmolar therapy use in patients with edema and herniation rather than those agents leading to worse outcomes. Further studies should be performed to determine if hyperosmolar agents are effective in preventing poor outcomes.
KW - Hyperosmolar therapy
KW - hypertonic saline
KW - mannitol
KW - outcome
KW - spontaneous intracerebral hemorrhage
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U2 - 10.1016/j.jstrokecerebrovasdis.2017.11.013
DO - 10.1016/j.jstrokecerebrovasdis.2017.11.013
M3 - Article
C2 - 29305272
AN - SCOPUS:85039866758
SN - 1052-3057
VL - 27
SP - 1061
EP - 1067
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 4
ER -