Location-Specific Hematoma Volume Predicts Early Neurological Deterioration in Supratentorial ICH.

OBJECTIVE

Early neurological deterioration (END) adversely affects outcomes in patients with intracerebral hemorrhage (ICH). This study aimed to determine the location-specific hematoma volumes for END in supratentorial ICH patients.

METHODS

We retrospectively analyzed supratentorial ICH patients presenting from two prospective cohorts. END was defined as a ≥ 4-point increase in the National Institutes of Health Stroke Scale (NIHSS) score or a ≥ 2-point decrease in the Glasgow Coma Scale score within 24 h of admission. The training cohort was used to determine location-specific hematoma volume cutoffs for END and to develop the location-specific hematoma volume for early neurological deterioration (LIVED) score. Internal validation used 30% of the cohort, with external validation in a separate cohort.

RESULTS

A total of 1199 patients with supratentorial ICH were included, divided into training (n = 633), internal validation (n = 272), and external validation (n = 294) cohorts. Hematoma volume thresholds for END were 21 mL for basal ganglia, 12 mL for thalamus, and 32 mL for lobar hemorrhages. Multivariable logistic regression identified location-specific hematoma volume, right-sided ICH, prior ischemic stroke, and NIHSS score as independent predictors, forming the LIVED score (range 0-5 points). The LIVED score showed superior predictive performance for END compared with established ICH scores, with the highest area under the curve (AUC) across cohorts. Additionally, it exhibited strong discrimination for 3-month outcomes, including functional independence, poor outcomes, and mortality, with AUCs > 0.70 in all cohorts.

INTERPRETATION: Location-specific hematoma volume thresholds independently predicted END, and the LIVED score demonstrated reliable performance for risk stratification in supratentorial ICH.