Assessing etiological classification systems and their relationship with neurological deterioration in patients with intracerebral hemorrhage
Abstract Unlike ischemic stroke, there is no consensus on the etiological classification of intracerebral hemorrhage (ICH). Our study focuses on two commonly used classification systems: SMASH-U and H-ATOMIC. The association between these classifications and neurological deterioration (ND) as well a...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-07-01
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| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-025-07506-4 |
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| Summary: | Abstract Unlike ischemic stroke, there is no consensus on the etiological classification of intracerebral hemorrhage (ICH). Our study focuses on two commonly used classification systems: SMASH-U and H-ATOMIC. The association between these classifications and neurological deterioration (ND) as well as clinical outcomes remains largely unexplored. We aimed to determine whether the etiological groups defined by these classifications are related to ND during hospitalization. We prospectively recruited consecutive ICH patients from 2015 to 2022. Demographic, radiological and clinical characteristics were systematically recorded. Etiology was determined at discharge. Variables and etiological groups associated with ND were included in a multivariate logistic regression analysis. A total of 301 patients were recruited, of whom 124 patients (41.2%) experienced ND. The hypertensive subtype was the most frequent etiology with both classifications systems. In 149 (49.5%) more than one possible etiology for ICH was identified, with the most common combination being hypertension and either probable or possible amyloid angiopathy, in 64 patients (21.3%). ICH related to anticoagulation (AC) was associated with a greater risk of ND. In the multivariate analysis, certain etiological subtypes were independently associated with ND. In the SMASH-U classification, medication-related ICH was linked to a higher risk of ND (OR 6.02 95% CI 1.87–19.34). while in H-ATOMIC, the combination of HT and AC (OR 9.91 CI: 2.54–38.69), and combined groups (OR 17.49, CI: 3.86–79.30), were related to ND. Intraventricular extension, blood pressure control and initial volume were also related to ND. In addition, intraventricular extension, blood pressure control, and initial hematoma volume were also found to be related to ND. The etiology of the ICH could be related to the risk of ND during hospitalization. AC-related etiologies appear to confer the highest risk, particularly when combined with HT-related mechanisms. |
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| ISSN: | 2045-2322 |