Intracerebral Hemorrhage etiological classification systems and their correlation with neurological deterioration

IntroductionUnlike ischemic stroke, the etiological classification of patients with intracerebral hemorrhage (CH) lacks consensus. Our study focuses on two commonly-used classification systems: SMASH-U and H-ATOMIC. The main difference between them lies in the fact that the H-ATOMIC system considers the simultaneous presence of different etiologies in a single patient. The association between the two classifications with relation to neurological deterioration (ND) and clinical outcomes remains so far unexplored. MethodsWe recruited consecutive ICH patients from 2015 to 2022, determining etiology was on discharge. Demographic, radiological and clinical characteristics were recorded. ND during hospitalization in the 7 days after stroke was the main clinical endpoint. Results301 patients were recruited. 124 patients (41.2%) experienced ND. The hypertensive subtype was the most frequent etiology with both classifications. In 149 (49.5%) more than one possible etiology for the ICH were recognized. The most frequent combination was hypertension + either probable or possible amyloid angiopathy, in 64 patients (21.3%). Significant differences in ND proportions were observed across groups with both systems. ICH related to anticoagulation was associated with a greater risk of ND: 63.5 % in SMASH-U and 62.5% in patients with a combination of Hypertension and Oral Anticoagulants in H-ATOMIC. Both these etiological groups and that containing combined etiologies were statistically significant according to multivariate analysis. Intraventricular extension, blood pressure control and initial volume were also related to ND. ConclusionEtiology of the ICH could be related to the risk of ND during hospitalization. Anticoagulation-related etiologies may present the highest risk, especially when combined with hypertension.