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April 30, 2019; 92 (18) Null Hypothesis

Statins and perihemorrhagic edema in patients with spontaneous intracerebral hemorrhage

View ORCID ProfileJens Witsch, Fawaz Al-Mufti, E. Sander Connolly, Sachin Agarwal, Kara Melmed, David J. Roh, Jan Claassen, Soojin Park
First published February 6, 2019, DOI: https://doi.org/10.1212/WNL.0000000000006931
Jens Witsch
From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
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Fawaz Al-Mufti
From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
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E. Sander Connolly
From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
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Sachin Agarwal
From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
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Kara Melmed
From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
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David J. Roh
From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
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Jan Claassen
From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
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Soojin Park
From the Departments of Neurology (J.W., S.A., K.M., D.J.R., J.C., S.P.) and Neurosurgery (E.S.C.), Columbia University Medical Center, New York, NY; Department of Neurology (J.W.), Yale School of Medicine, New Haven, CT; and Departments of Neurology, Neurosurgery, and Radiology (F.A.-M.), Westchester Medical Center, New York Medical College, Valhalla.
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Statins and perihemorrhagic edema in patients with spontaneous intracerebral hemorrhage
Jens Witsch, Fawaz Al-Mufti, E. Sander Connolly, Sachin Agarwal, Kara Melmed, David J. Roh, Jan Claassen, Soojin Park
Neurology Apr 2019, 92 (18) e2145-e2149; DOI: 10.1212/WNL.0000000000006931

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Abstract

Objective To test the hypothesis that in patients with spontaneous intracerebral hemorrhage (ICH), perihemorrhagic edema to hematoma ratio (rPHE) on admission CT scan (aCT) is unaffected by home statin use when time from symptom onset to aCT is controlled for.

Methods In a single-center prospective cohort of 176 consecutive ICH patients, 2 investigators independently determined hematoma and perihemorrhagic edema (PHE) volumes by using semiautomated validated software. rPHE were dichotomized at the median ratio (>0.75 vs ≤0.75). We used binary logistic regression to test for associations with rPHE.

Results In patients using statins as home medication before hospital admission (n = 38) compared to patients without prior statin use (n = 138), median PHE volumes were 15.8 mL (interquartile range [IQR] 6.5–39.4) vs 10.8 mL (IQR 5.1–26.8), p = 0.2. rPHE was 0.71 (IQR 0.56–1.0) vs 0.74 (IQR 0.52–1.0), p = 0.79. In a binary logistic regression model, time of aCT relative to symptom onset (odds ratio [OR] 1.02, confidence interval [CI] 1.01–1.12, p = 0.016) and presence of intraventricular hemorrhage on aCT (OR 0.40, CI 0.20–0.78, p = 0.007) were but prior statin use was not (OR 1.17, CI 0.55–2.52, p = 0.68) associated with rPHE.

Conclusion Use of statins before hospital admission for ICH is not associated with reduced rPHE on admission CT. In future studies, imaging timing relative to ICH onset needs to be controlled for in order to avoid confounding.

Glossary

aCT=
admission CT;
ICH=
intracerebral hemorrhage;
IVH=
intraventricular hemorrhage;
PHE=
perihemorrhagic edema;
rPHE=
perihemorrhagic edema to hematoma ratio

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Received July 22, 2018.
  • Accepted in final form December 14, 2018.
  • © 2019 American Academy of Neurology
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