Acute hematoma expansion after spontaneous intracerebral hemorrhage: risk factors and impact on long-term prognosis

Introduction: Hematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with short-term mortality, but its impact on long-term prognosis is still unclear. The aim of this study was to evaluate the impact of HE on long-term survival and functional status after spontaneous ICH. Methods: Consecutive patients admitted with spontaneous ICH were prospectively enrolled and followed up for a minimum of 2 years. We compared short-term (< 30 days) and long-term survival and functional status between ICH patients with HE (HE+) and those without (HE-). Main outcomes were mortality and poor outcome, defined as modified Rankin Scale ≥ 3. Secondary outcomes included recurrent ICH, admission to institutionalized care, and ischemic events (stroke, myocardial infarction, and systemic embolism). Results: Overall, 140 patients were included (mean age 74.9 years, male 59.3%) and followed up for a mean of 2.25 years. HE+ patients (25.7%) had larger hematoma volume at admission (23.8 ml vs 15.3 ml, p < 0.05), higher NIHSS score (14.6 vs 10.5, p < 0.05) and higher cumulative mortality (59.3% vs 39.2%, p < 0.05) compared to HE- patients. Survival analysis showed that HE+ confers higher mortality and worse functional status at all time points. HE did not associate with secondary outcomes. Discussion: HE translates into higher mortality and functional dependence over long-term follow-up. Strategies limiting HE might benefit long-term functional status.