Evidence map›Paper›PMID 30120039›Full record

SynthesisThe Lancet. Neurology2018

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data.

Rustam Al-Shahi Salman, Joseph Frantzias, Robert J Lee, Patrick D Lyden, Thomas W K Battey, Alison M Ayres, Joshua N Goldstein, Stephan A Mayer, Thorsten Steiner, Xia Wang and 56 more

Erratum issuedAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 208 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
208citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

208 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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  5. Surgery for spontaneous supratentorial intracerebral haemorrhage.The Cochrane database of systematic reviews · 2025
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148 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

66 authors.

Rustam Al-Shahi SalmanCentre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. Electronic address: rustam.al-shahi@ed.ac.uk.
Joseph FrantziasDepartment of Neurosurgery, King's College Hospital, London, UK.
Robert J LeeUsher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Patrick D LydenDepartment of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Thomas W K BatteyDepartment of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Alison M AyresDepartment of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Joshua N GoldsteinDepartment of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Stephan A MayerDepartment of Neurology, Henry Ford Health System, Detroit, MI, USA.
Thorsten SteinerDepartment of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Xia WangThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Hisatomi ArimaThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Hitoshi HasegawaDepartment of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
Makoto OishiDepartment of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
Daniel A GodoyIntensive Care Unit, Hospital Interzonal de Agudos "San Juan Bautista", Catamarca, Argentina.
Luca MasottiInternal Medicine, Santa Maria Nuova Hospital, Florence, Italy.
Dar DowlatshahiDepartment of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
David Rodriguez-LunaStroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain.
Carlos A MolinaStroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain.
Dong-Kyu JangDepartment of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Antonio DavalosDepartment of Neurosciences, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain.
José CastilloDepartment of Neurology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.
Xiaoying YaoDepartment of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Jan ClaassenDepartment of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
Bastian VolbersDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
Seiji KazuiKazui Medical Office, Ikeda, Osaka, Japan.
Yasushi OkadaDepartment of Cerebrovascular Medicine and Neurology, National Hospital Organisation Kyushu Medical Centre, Fukuoka, Japan.
Shigeru FujimotoDivision of Neurology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Kazunori ToyodaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Qi LiDepartment of Neurology, ThE First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Jane KhouryUniversity of Cincinnati Medical Centre, Cincinnati, OH, USA.
Pilar DelgadoNeurovascular Research Lab, Neurovascular Section, Institut de Recerca and Hospital Vall d'Hebron, Barcelona, Spain.
José Álvarez SabínNeurovascular Research Lab, Neurovascular Section, Institut de Recerca and Hospital Vall d'Hebron, Barcelona, Spain.
Mar Hernández-GuillamonNeurovascular Research Lab, Neurovascular Section, Institut de Recerca and Hospital Vall d'Hebron, Barcelona, Spain.
Luis Prats-SánchezDepartment of Neurology, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain.
Chunyan CaiCentre for Clinical and Translational Sciences, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA.
Mahesh P KateDepartment of Neurology, University of Alberta, Edmonton, AB, Canada.
Rebecca McCourtDepartment of Neurology, University of Alberta, Edmonton, AB, Canada.
Chitra VenkatasubramanianDivision of Stroke and Neurocritical Care, Stanford University, Palo Alto, CA, USA.
Michael N DiringerDepartment of Neurology and Neurological Surgery, Washington University, St Louis, MO, USA.
Yukio IkedaDepartment of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
Hans WorthmannDepartment of Neurology, Hannover Medical School, Hannover, Germany.
Wendy C ZiaiJohns Hopkins University School of Medicine, Department of Neurology, Anaesthesia and Critical Care Medicine, Division of Neurocritical Care, Baltimore, MD, USA.
Christopher D d'EsterreDepartment of Radiology, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Richard I AvivDepartment of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Peter RaabInstitute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany.
Yasuo MuraiDepartment of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
Allyson R ZazuliaDepartment of Neurology and Neurological Surgery, Washington University, St Louis, MO, USA.
Kenneth S ButcherDepartment of Neurology, University of Alberta, Edmonton, AB, Canada.
Seyed Mohammad SeyedsaadatDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
James C GrottaMemorial Hermann Hospital, Clinical Innovation and Research Institute, Houston, TX, USA.
Joan Martí-FàbregasDepartment of Neurology, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain.
Joan MontanerNeurovascular Research Lab, Neurovascular Section, Institut de Recerca and Hospital Vall d'Hebron, Barcelona, Spain.
Joseph BroderickUniversity of Cincinnati Medical Centre, Cincinnati, OH, USA.
Haruko YamamotoCenter for Advanced Clinical and Translational Sciences, National Cerebral and Cerebrovascular Center, Suita, Osaka, Japan.
Dimitre StaykovDepartment of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Neurology, Hospital of the Brothers of St John, Eisenstadt, Austria.
E Sander ConnollyDepartment of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
Magdy SelimDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Rogelio LeiraDepartment of Neurology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.
Byung Hoo MoonDepartment of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Andrew M DemchukDepartment of Clinical Neurosciences and Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Mario Di NapoliNeurological Service, San Camillo de'Lellis General Hospital, Rieti, Italy.
Yukihiko FujiiDepartment of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
Craig S AndersonThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, China at Peking University Health Science Center, Beijing, China.
Jonathan RosandDepartment of Neurology, Massachusetts General Hospital, Boston, MA, USA.
VISTA-ICH Collaboration
ICH Growth Individual Patient Data Meta-analysis Collaborators

Funding

Center for Clinical and Translational Sciences (CCTS)UL1TR000371 · NCATS · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · PI MCPHERSON, DAVID D · 2012 to 2016
$13.4M
Genetic and Environmental Risk Factors for Hemorrhagic StrokeU01NS036695 · NINDS · UNIVERSITY OF CINCINNATI · PI ROSAND, JONATHAN, WOO, DANIEL · 2016 to 2020
$7.0M
British Heart Foundation FS/13/72/30531Medical Research Council G0800803Medical Research Council G1002605NCATS NIH HHS UL1 TR000371NINDS NIH HHS U01 NS036695
6 · The paper itself

Abstract

backgroundIntracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography.

methodsIn a systematic review of OVID MEDLINE-with additional hand-searching of relevant studies' bibliographies- from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5-24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known.

findingsOf 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56-76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36-0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46-11·60; p<0·0001), antiplatelet use (1·68, 1·06-2·66; p=0·026), and anticoagulant use (3·48, 1·96-6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75-0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95-6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03-0·07).

interpretationIn this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects in prior randomised trials, and guide the design of future trials.

fundingUK Medical Research Council and British Heart Foundation.

Indexed as

Cerebral HemorrhageDisease ProgressionAgedHumansMiddle AgedOutcome Assessment, Health CareRisk Assessment

Identifiers

PMID30120039
PMCPMC6143589

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.