{
  "abstract": "Background Perihematomal edema (PHE) is a secondary injury mechanism following intracerebral hemorrhage (ICH) that contributes to neurological deterioration and poor outcomes. While PHE volume and expansion have been extensively studied, the prognostic significance of PHE timing remains poorly characterized. Early PHE development may reflect different pathophysiological processes than delayed PHE, potentially influencing long-term survival and functional outcomes. We investigated the association between timing of PHE development and clinical outcomes in a large multicenter cohort.Methods Using the TriNetX Research Network (111 healthcare organizations), we identified adults with nontraumatic ICH (ICD-10: I61) and subsequent cerebral edema (ICD-10: G93.6) from January 2015 to January 2026. Patients were stratified by timing of PHE: early PHE (edema within 24 hours of ICH) versus delayed PHE (edema 1-3 days after ICH). Propensity score matching (1:1) balanced cohorts on demographics (age, sex, race/ethnicity), comorbidities (hypertension, diabetes, heart failure, atrial fibrillation, ischemic heart disease, hyperlipidemia, coagulation defects, obesity, chronic kidney disease, peripheral vascular disease, liver disease, cerebral atherosclerosis), hemorrhage characteristics (intraventricular hemorrhage, subarachnoid hemorrhage, cerebral infarction), and medications (beta blockers, calcium channel blockers, antiarrhythmics, antilipemic agents, ACE inhibitors, angiotensin II inhibitors, antiplatelet agents, anticoagulants). Outcomes assessed included all-cause mortality and functional dependency (defined as gastrostomy, tracheostomy, or documented need for assistance with activities of daily living). Cox proportional hazards regression estimated hazard ratios (HR) with 95% confidence intervals.Results After propensity score matching, 29,815 matched pairs were analyzed. Cohorts were well-balanced: mean age 62.6 versus 62.8 years; female 46.5% versus 46.4%; White 64.2% versus 64.4%; Black 19.4% versus 19.7%; hypertension 78.6% versus 78.4%; diabetes 31.4% versus 31.9%; intraventricular hemorrhage 32.0% versus 30.9%. Mean follow-up was 646 versus 641 days. Delayed PHE was associated with significantly lower mortality compared to early PHE (32.2% vs 34.4%; HR 0.92, 95% CI 0.90-0.95; p<0.001). Median survival was 2,795 days for delayed PHE versus 2,356 days for early PHE. However, delayed PHE was associated with significantly higher rates of functional dependency (13.8% vs 12.4%; HR 1.13, 95% CI 1.08-1.18; p<0.001). This survival-dependency paradox persisted across sensitivity analyses.Conclusions In this large multicenter cohort, delayed PHE development was associated with improved survival but increased functional dependency compared to early PHE. This survival-dependency paradox may reflect survivorship bias, whereby patients who survive the acute phase have more opportunity to develop long-term disability. Alternatively, early versus delayed PHE may represent distinct pathophysiological processes with different prognostic implications. These findings suggest that PHE timing should be incorporated into prognostic models and may inform goals-of-care discussions. Further research is needed to elucidate the mechanisms underlying differential outcomes based on PHE timing.Disclosures M. Essibayi: None.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "M Essibayi"
    },
    {
      "affiliations": [
        "Bronx, NY"
      ],
      "name": "D Lakhani"
    },
    {
      "affiliations": [
        "Bronx, NY"
      ],
      "name": "D Altschul"
    }
  ],
  "title": "E-089 Timing of perihematomal edema development and long-term outcomes after intracerebral hemorrhage: a propensity score-matched analysis",
  "uid": "d18f2279-109b-5acd-ae27-fc7850b49e03"
}