Cerebral Small Vessel Disease and Functional Outcome Prediction after Intracerebral Haemorrhage

I C Hostettler, G Schwarz, G Ambler, D Wilson, G Banerjee, D Seiffge, C Shakeshaft, S Lunawat, H Cohen, T Yousry, R Al-Shahi Salman, Gyh Lip, M M Brown, K W Muir, H Houlden, H R Jäger, D J Werring

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH), and whether these biomarkers improve the performance of pre-existing ICH score.

METHODS: We included 864 patients with acute ICH from a multicentre, hospital-based prospective cohort study. We evaluated CT-based SVD biomarkers (white matter hypodensities [WMH]; lacunes; brain atrophy; and a composite SVD burden score) and their associations with poor 6-month functional outcome (modified Rankin Scale [mRS] score >2). The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow test were used to assess discrimination and calibration of the ICH score with and without SVD biomarkers.

RESULTS: In multivariable models (adjusted for ICH score components), WMH presence (OR 1.52, 95%CI 1.12-2.06), cortical atrophy presence (OR 1.80, 95%CI 1.19-2.73), deep atrophy presence (OR 1.66, 95%CI 1.17-2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95%CI 1.36-2.74) were independently associated with poor functional outcome. For the ICH score, the AUROC was 0.71 (95%CI 0.68-0.74). Adding SVD markers did not significantly improve ICH score discrimination; for the best model (adding severe atrophy) the AUROC was 0.73 (95%CI 0.69-0.76). These results were confirmed when considering lobar and non-lobar ICH, separately.

CONCLUSIONS: The ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome but adding them does not significantly improve ICH score discrimination.

Original languageEnglish
Early online date24 Feb 2021
Publication statusE-pub ahead of print - 24 Feb 2021


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