ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1634441
Predicting Hemorrhage Expansion in Patients with Hypertensive Intracerebral Hemorrhage: The HE-VSD-A2TP Score
Provisionally accepted
- 1Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- 2The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Background: Hematoma expansion (HE) in hypertensive intracerebral hemorrhage (HICH) is significantly associated with patient mortality. Early identification of HE would be planning for appropriate and aggressive management for improving outcome and containing HE. Existing HE prediction models show variable accuracy across settings. To address this limitation, we developed and validate a new predictive model to enhance the accuracy of HE in patients with HICH.Methods: We conducted a retrospective cohort study using data from two centers. The primary outcome was the occurrence of HE within 24 hours of symptom onset, defined as an increase in hematoma volume ≥33% or ≥12.5 ml on follow-up imaging. Logistic regression was used to identify independent predictors of HE, and the HE-VSD-A2TP score system was developed and validated. Results: 567 patients in the derivation cohort and 378 patients in the validation cohort. The HE-VSD-A2TP score included age, uncontrolled blood pressure, hematoma volume, irregularity/lobulation shape, non-homogeneous density, presentation within 6 hours from symptom onset to CT, and the use of anticoagulation/antiplatelet therapy. The HE-VSD-A2TP score demonstrated superior discrimination in predicting HE compared to existing models like PREDICT, 9-point, and BRAIN scores, with an AUC of 0.871(95%CI 0.839-0.904) in the derivation cohort and 0.858 (95%CI 0.819-0.897) in the validation cohort. The score also showed excellent calibration and outperformed other models in terms of sensitivity, specificity, likelihood ratios, negative predictive value, and positive predictive value. With regard to clinical usefulness, the decision curve analysis (DCA) of HE-VSD-A2TP showed higher net benefit than PREDICT, 9-point, and BRAIN scores in the both cohorts.Conclusions: The HE-VSD-A2TP score was validated to be an effective tool for identifying patients at risk of HE in patients with HICH. It was a valuable tool for guiding clinical management strategies and potentially improving patient outcomes.
Keywords: intracerebral hemorrhage, Hematoma expansion, predictive model, risk stratification, clinical decision-making
Received: 24 May 2025; Accepted: 18 Jun 2025.
Copyright: © 2025 Zhu, Lin, Wang, Liu, Dai, Chen and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jian Chen, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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