Factors associated with hematoma expansion in deep versus lobar intracerebral haemorrhage: a multicentre observational study

INTRODUCTION: Identification of factors associated with haematoma expansion (HE) in patients with primary intracerebral haemorrhage (ICH) is crucial for optimization of management and therapeutic strategies. We investigated whether such factors differed according to supratentorial ICH location, comparing deep versus lobar ICH. METHODS: Retrospective analysis of patients with primary ICH admitted at nine sites. HE was defined as growth ≥6 mL and/or ≥33% from baseline to follow-up imaging. We evaluated independent associations using multivariable logistic regression models adjusted for age, sex, baseline haematoma volume, anticoagulants and antiplatelets use and other relevant confounders identified in univariate analyses. RESULTS: A total of 1768 patients were included (mean age 70 years, 56% males) of whom 1020 (58%) had deep and 748 (42%) had lobar ICH; HE occurred in 531 (30%) patients (28% deep and 33% lobar ICH). Age and baseline haematoma volume were shared predictors of HE in lobar and deep ICH. Anticoagulant use (OR = 1.61;95%, 1.04-2.50) and lower Glasgow Come Scale (OR = 0.91;95%CI, 0.85-0.96) were associated with HE only in lobar ICH, whereas the associations between systolic blood pressure >140 mmHg (OR = 1.53;95%CI, 1.03-2.29) and presentation before 3 h from onset (OR = 1.40;95%CI, 1.02-1.92) and HE were observed only in patients with deep ICH. CONCLUSIONS: Some factors associated with HE were shared between deep and lobar ICH whereas others appeared to be location-specific. Our findings may reflect differences in the pathophysiology of HE according to ICH location and might improve the stratification of HE risk in clinical practice or randomized trials.