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Background <p>Hematoma expansion (HE) is a key determinant of poor outcomes in intracerebral hemorrhage (ICH), but its frequency and predictors in wake-up ICH remain insufficiently characterized. This study aimed to compare HE between wake-up and clear-onset ICH and to identify predictors of HE in wake-up ICH.</p> Methods <p>We analyzed patients with spontaneous ICH from a prospective cohort between August 2022 and September 2025. The primary outcome was HE defined as an absolute increase in volume &gt; 6&#xa0;mL or &gt; 33% from baseline on follow-up computed tomography (CT). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 3&#xa0;months. Baseline characteristics, HE rates, and outcomes were compared between wake-up ICH and clear-onset ICH groups. Logistic regression analyses were performed to identify predictors of HE and poor outcome in wake-up ICH.</p> Results <p>Among 415 patients, 66 (15.9%) had wake-up ICH. The frequency of HE was comparable between wake-up and clear-onset ICH (35.2% vs. 24.7%; p = 0.115), as were 3-month functional outcomes and mortality (all p &gt; 0.05). HE was independently associated with poor 3-month outcome among wake-up ICH. Hypodensities (OR = 3.96, 95% CI: 1.08–15.77, p = 0.044) and irregular shape (OR = 3.95, 95% CI: 1.09–15.49, p = 0.040) were independently associated with HE among wake-up ICH.</p> Conclusion <p>HE is common and associated with poor outcomes in wake-up ICH. Noncontrast CT markers, including hypodensities and irregular shape, may serve as imaging markers for risk stratification of HE in wake-up ICH.</p> Graphical abstract <p></p>

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The frequency and predictors of hematoma expansion in wake-up intracerebral hemorrhage

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Han Wang,
  • Zijie Wang,
  • Rui Cheng,
  • Xiao Hu,
  • Chu Chen,
  • Juan Li,
  • Tiannan Yang,
  • Sijia Liu,
  • Yue Sun,
  • Qi Li

摘要

Background

Hematoma expansion (HE) is a key determinant of poor outcomes in intracerebral hemorrhage (ICH), but its frequency and predictors in wake-up ICH remain insufficiently characterized. This study aimed to compare HE between wake-up and clear-onset ICH and to identify predictors of HE in wake-up ICH.

Methods

We analyzed patients with spontaneous ICH from a prospective cohort between August 2022 and September 2025. The primary outcome was HE defined as an absolute increase in volume > 6 mL or > 33% from baseline on follow-up computed tomography (CT). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 3 months. Baseline characteristics, HE rates, and outcomes were compared between wake-up ICH and clear-onset ICH groups. Logistic regression analyses were performed to identify predictors of HE and poor outcome in wake-up ICH.

Results

Among 415 patients, 66 (15.9%) had wake-up ICH. The frequency of HE was comparable between wake-up and clear-onset ICH (35.2% vs. 24.7%; p = 0.115), as were 3-month functional outcomes and mortality (all p > 0.05). HE was independently associated with poor 3-month outcome among wake-up ICH. Hypodensities (OR = 3.96, 95% CI: 1.08–15.77, p = 0.044) and irregular shape (OR = 3.95, 95% CI: 1.09–15.49, p = 0.040) were independently associated with HE among wake-up ICH.

Conclusion

HE is common and associated with poor outcomes in wake-up ICH. Noncontrast CT markers, including hypodensities and irregular shape, may serve as imaging markers for risk stratification of HE in wake-up ICH.

Graphical abstract