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Defining the Optimal Midline Shift Threshold to Predict Poor Outcome in Patients with Supratentorial Spontaneous Intracerebral Hemorrhage

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Abstract

Background

Midline shift (MLS) has been associated with unfavorable outcome in patients with intracerebral hemorrhage (ICH). However, the optimal criteria to define the MLS measurements that indicate future outcome in ICH patients are absent, and the quantitative threshold of MLS that differentiates favorable and poor clinical outcome should be further explored.

Methods

We enrolled patients with ICH who underwent admission computed tomography (CT) within 6 h after onset of symptoms. We assessed MLS at several locations, including the pineal gland, septum pellucidum, and cerebral falx. MLS(max) was defined as the maximum midline shift among these locations. Functional outcomes were assessed with the Modified Rankin Scale (mRS) at 3 months. We performed multivariate logistic regression analysis to investigate the MLS locations for predicting poor outcome. ROC curve analysis was used to establish whether MLS values were predictive of 90-day poor outcome.

Results

In 199 patients with ICH, 78 (39.2%) patients had poor functional outcome at 3-month follow-up. Pineal gland shift, septum pellucidum shift, cerebral falx shift, and MLS(max) all showed a significant difference between poor outcome and favorable outcome (p < 0.001). After adjustment for age, baseline Glasgow Coma Scale score, ICH location, time to initial CT, baseline ICH volume, and intraventricular hemorrhage, the MLS(max) was independently associated with poor outcome (p = 0.032). MLS(max) > 4 mm (our proposed optimal threshold) was more likely to have poorer outcomes than those without (p < 0.001).

Conclusions

MLS(max) can be a good independent predictor of clinical outcome, and MLS(max) > 4 mm is an optimal threshold associated with poor outcome in patients with ICH.

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (Grant Nos. 81200899, 81371310) and the National Basic Research Program of China (973 Program) (Grant No. 2009CB918300).

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Authors and Affiliations

  1. Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China

    Wen-Song Yang, Qing-Jun Liu, Li-Bo Zhao & Peng **e

  2. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Qi Li, Rui Li & **ng-Chen Wang

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  1. Wen-Song Yang
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  2. Qi Li
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  3. Rui Li
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  4. Qing-Jun Liu
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  7. Peng **e
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Contributions

W-SY, QL, and PX contributed to the conception and design of the article. W-SY, QL, Q-JL, RL, X-CW, L-BZ, and PX all contributed to data collection, data interpretation, and data analysis. W-SY contributed to drafting of the manuscript. PX and QL contributed to administrative, technical, or material support. All authors contributed to revising the article for important intellectual content and gave final approval of the version to be published.

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Correspondence to Qi Li or Peng **e.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Yang, WS., Li, Q., Li, R. et al. Defining the Optimal Midline Shift Threshold to Predict Poor Outcome in Patients with Supratentorial Spontaneous Intracerebral Hemorrhage. Neurocrit Care 28, 314–321 (2018). https://doi.org/10.1007/s12028-017-0483-7

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