AUTHOR=Jin Yu-jia , Li Jia-wen , Wu Jian , Huang Yu-hui , Yang Kai-cheng , An Hong-na , Yuan Chang-zheng , Gao Feng , Tong Lu-sha 

TITLE=Cortical superficial siderosis, hematoma volume, and outcomes after intracerebral hemorrhage: a mediation analysis

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1122744

DOI=10.3389/fneur.2023.1122744

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>Previous studies have shown that cortical superficial siderosis (cSS) can increase hematoma volume and predict poor outcomes following primary intracerebral hemorrhage (ICH).</p></sec><sec><title>Objective</title><p>We aimed to determine whether a large hematoma volume was the essential factor contributing to worse outcomes of cSS.</p></sec><sec><title>Methods</title><p>Patients with spontaneous ICH underwent a CT scan within 48 h after ictus. Evaluation of cSS was performed using magnetic resonance imaging (MRI) within 7 days. The 90-day outcome was assessed using the modified Rankin Scale (mRS). In addition, we investigated the correlation between cSS, hematoma volume, and 90-day outcomes using multivariate regression and mediation analyses.</p></sec><sec><title>Results</title><p>Among the 673 patients with ICH [mean (SD) age, 61 (13) years; 237 female subjects (35.2%); median (IQR) hematoma volume, 9.0 (3.0–17.6) ml], 131 (19.5%) had cSS. There was an association between cSS and larger hematoma volume (β = 4.449, 95% CI 1.890–7.009, <italic>p</italic> &lt; 0.001) independent of hematoma location and was also related to worse 90-day mRS (β = 0.333, 95% CI 0.008–0.659, <italic>p</italic> = 0.045) in multivariable regression. In addition, mediation analyses revealed that hematoma volume was an essential factor mediating the effect of cSS on unfavorable 90-day outcomes (proportion mediated:66.04%, <italic>p</italic> = 0.01).</p></sec><sec><title>Conclusion</title><p>Large hematoma volume was the major charge of directing cSS to worse outcomes in patients with mild to moderate ICH, and cSS was related to a larger hematoma in both lobar and non-lobar areas.</p></sec><sec><title>Clinical trial registration</title><p><ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT04803292" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT04803292</ext-link>, identifier: NCT04803292.</p></sec>