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Article ; Online: The author replies.

Roh, David

2023 Volume 51, Issue 5, Page(s) e123–e124

Language	English
Publishing date	2023-04-13
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005831
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Article ; Online: Author response: Low hemoglobin and hematoma expansion after intracerebral hemorrhage.

Roh, David J

Neurology

2020 Volume 94, Issue 23, Page(s) 1052

MeSH term(s)	Cerebral Hemorrhage ; Hematoma ; Hemoglobins ; Humans
Chemical Substances	Hemoglobins
Language	English
Publishing date	2020-06-08
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000009608
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Article ; Online: Transfusion medicine approaches for spontaneous intracerebral hemorrhage patients.

Stone, Elizabeth F / Poyraz, Fernanda Carvalho / Roh, David J

Current opinion in critical care

2023 Volume 29, Issue 2, Page(s) 50–60

Abstract: Purpose of review: Spontaneous intracerebral hemorrhage (ICH) is the deadliest stroke subtype. Acute treatments necessitate rapid hemorrhage control to minimize secondary brain injury. Here, we discuss the overlap of transfusion medicine and acute ICH ... ...

Abstract	Purpose of review: Spontaneous intracerebral hemorrhage (ICH) is the deadliest stroke subtype. Acute treatments necessitate rapid hemorrhage control to minimize secondary brain injury. Here, we discuss the overlap of transfusion medicine and acute ICH care relating to diagnostic testing and therapies relevant for coagulopathy reversal and secondary brain injury prevention. Recent findings: Hematoma expansion (HE) is the largest contributor to poor outcomes after ICH. Conventional coagulation assays to diagnose coagulopathy after ICH does not predict HE. Given the testing limitations, empiric pragmatic hemorrhage control therapies have been trialed but have not improved ICH outcomes, with some therapies even causing harm. It is still unknown whether faster administration of these therapies will improve outcomes. Alternative coagulation tests (e.g., viscoelastic hemostatic assays, amongst others) may identify coagulopathies relevant for HE, currently not diagnosed using conventional assays. This provides opportunities for rapid, targeted therapies. In parallel, ongoing work is investigating alternative treatments using transfusion-based or transfusion-sparing pharmacotherapies that can be implemented in hemorrhage control strategies after ICH. Summary: Further work is needed to identify improved laboratory diagnostic approaches and transfusion medicine treatment strategies to prevent HE and optimize hemorrhage control in ICH patients, who appear particularly vulnerable to the impacts of transfusion medicine practices.
MeSH term(s)	Humans ; Transfusion Medicine ; Cerebral Hemorrhage/therapy ; Stroke/therapy ; Brain Injuries ; Critical Care
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Review ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000001027
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Article ; Online: Association Between Soluble Intercellular Adhesion Molecule-1 and Intracerebral Hemorrhage Outcomes in the FAST Trial.

Witsch, Jens / Roh, David / Oh, Stephanie / Iadecola, Costantino / Diaz-Arrastia, Ramon / Kasner, Scott E / Mayer, Stephan A / Murthy, Santosh B

Stroke

2023 Volume 54, Issue 7, Page(s) 1726–1734

Abstract: Background: Neutrophil-mediated inflammation in the acute phase of intracerebral hemorrhage (ICH) worsens outcome in preclinical studies. sICAM-1 (soluble intercellular adhesion molecule-1), an inducible ligand for integrins and cell-cell adhesion ... ...

Abstract	Background: Neutrophil-mediated inflammation in the acute phase of intracerebral hemorrhage (ICH) worsens outcome in preclinical studies. sICAM-1 (soluble intercellular adhesion molecule-1), an inducible ligand for integrins and cell-cell adhesion molecules, is critical for neutrophil extravasation. We aimed to determine whether serum levels of sICAM-1 are associated with worse outcomes after ICH. Methods: We conducted a post hoc secondary analysis of an observational cohort using data from the FAST trial (Factor-VII for Acute Hemorrhagic Stroke Treatment). The study exposure was the admission serum level of sICAM-1. The coprimary outcomes were mortality and poor outcome (modified Rankin Scale score 4-6) at 90 days. Secondary radiological outcomes were hematoma expansion at 24 hours and perihematomal edema expansion at 72 hours. We used multiple linear and logistic regression analyses to test for associations between sICAM-1 and outcomes, after adjustment for demographics, ICH severity characteristics, change in the systolic blood pressure in the first 24 hours, treatment randomization arm, and the time from symptom onset to study drug administration. Results: Of 841 patients, we included 507 (60%) with complete data. Hematoma expansion occurred in 169 (33%), while 242 (48%) had a poor outcome. In multivariable analyses, sICAM-1 was associated with mortality (odds ratio, 1.53 per SD increase [95% CI, 1.15-2.03]) and poor outcome (odds ratio, 1.34 per SD increase [CI, 1.06-1.69]). In multivariable analyses of secondary outcomes, sICAM-1 was associated with hematoma expansion (odds ratio, 1.35 per SD increase [CI, 1.11-1.66]), but was not associated with log-transformed perihematomal edema expansion at 72 hours. In additional analyses stratified by treatment assignment, similar results were noted in the recombinant activated factor-VII arm, but not in the placebo arm. Conclusions: Admission serum levels of sICAM-1 were associated with mortality, poor outcome, and hematoma expansion. Given the possibility of a biological interaction between recombinant activated factor-VII and sICAM-1, these findings highlight the need to further explore the role of sICAM-1 as a potential marker of poor ICH outcomes.
MeSH term(s)	Humans ; Intercellular Adhesion Molecule-1/therapeutic use ; Prospective Studies ; Cerebral Hemorrhage/complications ; Stroke/complications ; Hematoma/drug therapy
Chemical Substances	Intercellular Adhesion Molecule-1 (126547-89-5)
Language	English
Publishing date	2023-05-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.123.042466
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Article ; Online: Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH-UP Criteria.

Sariyeva, Mehriban / Haghighi, Noora / Mitchell, Amanda / Booker, Whitney A / Petersen, Nils H / Shields, Andrea D / Ghoshal, Shivani / Agarwal, Sachin / Park, Soojin / Claassen, Jan / Connolly, E Sander / Roh, David J / Miller, Eliza C

Journal of the American Heart Association

2024 Volume 13, Issue 7, Page(s) e034032

Abstract: Background: Intracerebral hemorrhage (ICH) is a major cause of maternal morbidity, but its pathophysiology is poorly characterized. We investigated characteristics of pregnancy-associated ICH (P-ICH), compared with ICH in similar aged nonpregnant adults ...

Abstract	Background: Intracerebral hemorrhage (ICH) is a major cause of maternal morbidity, but its pathophysiology is poorly characterized. We investigated characteristics of pregnancy-associated ICH (P-ICH), compared with ICH in similar aged nonpregnant adults of both sexes. Methods and results: We performed a retrospective analysis of 134 adults aged 18 to 44 years admitted to our center with nontraumatic ICH from January 1, 2012, to December 31, 2021. We compared ICH characteristics among 3 groups: those with P-ICH (pregnant or within 12 months of end of pregnancy); nonpregnant women; and men. We categorized ICH pathogenesis according to a modified scheme, SMASH-UP (structural, medications, amyloid angiopathy, systemic, hypertension, undetermined, posterior reversible encephalopathy syndrome/reversible cerebral vasoconstriction syndrome), and calculated odds ratios and 95% CIs for primary (spontaneous small-vessel) ICH versus secondary ICH (structural lesions or coagulopathy related), using nonpregnant women as the reference. We also compared specific ICH pathogenesis by SMASH-UP criteria and functional outcomes between groups. Of 134 young adults with nontraumatic ICH, 25 (19%) had P-ICH, of which 60% occurred postpartum. Those with P-ICH had higher odds of primary ICH compared with nonpregnant women (adjusted odds ratio, 4.5 [95% CI, 1.4-14.7]). The odds of primary ICH did not differ between men and nonpregnant women. SMASH-UP pathogenesis for ICH differed significantly between groups ( Conclusions: In our cohort of young adults with ICH, 1 in 5 was pregnancy related. P-ICH differed in pathogenesis compared with non-pregnancy-related ICH in young adults, suggesting unique pathophysiology.
MeSH term(s)	Male ; Pregnancy ; Humans ; Female ; Young Adult ; Retrospective Studies ; Posterior Leukoencephalopathy Syndrome/complications ; Cerebral Hemorrhage/etiology ; Hypertension/complications ; Pregnancy Complications
Language	English
Publishing date	2024-03-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.123.034032
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Article ; Online: ABO blood type and thromboembolic complications after intracerebral hemorrhage: An exploratory analysis.

Ironside, Natasha / Melmed, Kara / Chen, Ching-Jen / Dabhi, Nisha / Omran, Setareh / Park, Soojin / Agarwal, Sachin / Connolly, E Sander / Claassen, Jan / Hod, Eldad A / Roh, David

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2024 Volume 33, Issue 5, Page(s) 107678

Abstract: Background and purpose: Non-O blood types are known to be associated with thromboembolic complications (TECs) in population-based studies. TECs are known drivers of morbidity and mortality in intracerebral hemorrhage (ICH) patients, yet the ... ...

Abstract	Background and purpose: Non-O blood types are known to be associated with thromboembolic complications (TECs) in population-based studies. TECs are known drivers of morbidity and mortality in intracerebral hemorrhage (ICH) patients, yet the relationships of blood type on TECs in this patient population are unknown. We sought to explore the relationships between ABO blood type and TECs in ICH patients. Methods: Consecutive adult ICH patients enrolled into a prospective observational cohort study with available ABO blood type data were analyzed. Patients with cancer history, prior thromboembolism, and baseline laboratory evidence of coagulopathy were excluded. The primary exposure variable was blood type (non-O versus O). The primary outcome was composite TEC, defined as pulmonary embolism, deep venous thrombosis, ischemic stroke or myocardial infarction, during the hospital stay. Relationships between blood type, TECs and clinical outcomes were separately assessed using logistic regression models after adjusting for sex, ethnicity and ICH score. Results: Of 301 ICH patients included for analysis, 44% were non-O blood type. Non-O blood type was associated with higher admission GCS and lower ICH score on baseline comparisons. We identified TECs in 11.6% of our overall patient cohort. . Although TECs were identified in 9.9% of non-O blood type patients compared to 13.0% in O blood type patients, we did not identify a significant relationship of non-O blood type with TECs (adjusted OR=0.776, 95%CI: 0.348-1.733, p=0.537). The prevalence of specific TECs were also comparable in unadjusted and adjusted analyses between the two cohorts. In additional analyses, we identified that TECs were associated with poor 90-day mRS (adjusted OR=3.452, 95% CI: 1.001-11.903, p=0.050). We did not identify relationships between ABO blood type and poor 90-day mRS (adjusted OR=0.994, 95% CI:0.465-2.128, p=0.988). Conclusions: We identified that TECs were associated with worse ICH outcomes. However, we did not identify relationships in ABO blood type and TECs. Further work is required to assess best diagnostic and prophylactic and treatment strategies for TECs to improve ICH outcomes.
MeSH term(s)	Adult ; Humans ; Prospective Studies ; Cerebral Hemorrhage/diagnosis ; Thromboembolism/diagnosis ; Thromboembolism/epidemiology ; Thromboembolism/etiology ; Logistic Models ; Pulmonary Embolism/complications
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2024.107678
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Article ; Online: Brain Multimodality Monitoring: Updated Perspectives.

Roh, David / Park, Soojin

Current neurology and neuroscience reports

2016 Volume 16, Issue 6, Page(s) 56

Abstract: The challenges posed by acute brain injury (ABI) involve the management of the initial insult in addition to downstream inflammation, edema, and ischemia that can result in secondary brain injury (SBI). SBI is often subclinical, but can be detected ... ...

Abstract	The challenges posed by acute brain injury (ABI) involve the management of the initial insult in addition to downstream inflammation, edema, and ischemia that can result in secondary brain injury (SBI). SBI is often subclinical, but can be detected through physiologic changes. These changes serve as a surrogate for tissue injury/cell death and are captured by parameters measured by various monitors that measure intracranial pressure (ICP), cerebral blood flow (CBF), brain tissue oxygenation (PbtO2), cerebral metabolism, and electrocortical activity. In the ideal setting, multimodality monitoring (MMM) integrates these neurological monitoring parameters with traditional hemodynamic monitoring and the physical exam, presenting the information needed to clinicians who can intervene before irreversible damage occurs. There are now consensus guidelines on the utilization of MMM, and there continue to be new advances and questions regarding its use. In this review, we examine these recommendations, recent evidence for MMM, and future directions for MMM.
MeSH term(s)	Brain/physiopathology ; Brain Diseases/diagnostic imaging ; Brain Diseases/metabolism ; Brain Diseases/physiopathology ; Cerebrovascular Circulation/physiology ; Humans ; Intracranial Pressure/physiology ; Monitoring, Physiologic ; Multimodal Imaging
Language	English
Publishing date	2016-06
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2057363-7
ISSN	1534-6293 ; 1528-4042
ISSN (online)	1534-6293
ISSN	1528-4042
DOI	10.1007/s11910-016-0659-0
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Article ; Online: Can We Utilize Whole Blood Viscoelastic Coagulation Assays to Better Identify and Treat Coagulopathy in Patients With Intracerebral Hemorrhage?

Yoh, Nina / Sisti, Jonathan / Connolly, E Sander / Chang, Tiffany R / Roh, David

World neurosurgery

2021 Volume 147, Page(s) 217–219

MeSH term(s)	Blood Coagulation ; Blood Coagulation Disorders ; Cerebral Hemorrhage ; Humans
Language	English
Publishing date	2021-03-08
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2021.01.107
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Article: A generalizable physiological model for detection of Delayed Cerebral Ischemia using Federated Learning.

Elhussein, Ahmed / Megjhani, Murad / Nametz, Daniel / Weiss, Miriam / Savarraj, Jude / Kwon, Soon Bin / Roh, David J / Agarwal, Sachin / Sander Connolly, E / Velazquez, Angela / Claassen, Jan / Choi, Huimahn A / Schubert, Gerrit A / Park, Soojin / Gürsoy, Gamze

Proceedings. IEEE International Conference on Bioinformatics and Biomedicine

2024 Volume 2023, Page(s) 1886–1889

Abstract: Delayed cerebral ischemia (DCI) is a complication seen in patients with subarachnoid hemorrhage stroke. It is a major predictor of poor outcomes and is detected late. Machine learning models are shown to be useful for early detection, however training ... ...

Abstract	Delayed cerebral ischemia (DCI) is a complication seen in patients with subarachnoid hemorrhage stroke. It is a major predictor of poor outcomes and is detected late. Machine learning models are shown to be useful for early detection, however training such models suffers from small sample sizes due to rarity of the condition. Here we propose a Federated Learning approach to train a DCI classifier across three institutions to overcome challenges of sharing data across hospitals. We developed a framework for federated feature selection and built a federated ensemble classifier. We compared the performance of FL model to that obtained by training separate models at each site. FL significantly improved performance at only two sites. We found that this was due to feature distribution differences across sites. FL improves performance in sites with similar feature distributions, however, FL can worsen performance in sites with heterogeneous distributions. The results highlight both the benefit of FL and the need to assess dataset distribution similarity before conducting FL.
Language	English
Publishing date	2024-01-18
Publishing country	United States
Document type	Journal Article
ISSN	2156-1125
ISSN	2156-1125
DOI	10.1109/bibm58861.2023.10385383
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Article: Admission viscoelastic hemostatic assay parameters predict poor long-term intracerebral hemorrhage outcomes.

Sieh, Laura / Peasley, Emma / Mao, Eric / Mitchell, Amanda / Heinonen, Gregory / Ghoshal, Shivani / Agarwal, Sachin / Park, Soojin / Connolly, E Sander Sander / Claassen, Jan / Moore, Ernest E / Hansen, Kirk / Hod, Eldad A / Francis, Richard O / Roh, David

Research square

2024

Abstract: Background: Viscoelastic hemostatic assays (VHA) provide more comprehensive assessments of coagulation compared to conventional coagulation assays. While VHAs have enabled guided hemorrhage control therapies, improving clinical outcomes in life- ... ...

Abstract	Background: Viscoelastic hemostatic assays (VHA) provide more comprehensive assessments of coagulation compared to conventional coagulation assays. While VHAs have enabled guided hemorrhage control therapies, improving clinical outcomes in life-threatening hemorrhage, the role of VHAs in intracerebral hemorrhage (ICH) is unclear. If VHAs can identify coagulation abnormalities relevant for ICH outcomes, this would support the need to investigate the role of VHAs in ICH treatment paradigms. Thus, we investigated whether VHA assessments of coagulation relate to long-term ICH outcomes. Methods: Spontaneous ICH patients enrolled into a single-center cohort study receiving admission Rotational Thromboelastometry (ROTEM) VHA testing between 2013 and 2020 were assessed. Patients with prior anticoagulant use or coagulopathy on conventional coagulation assays were excluded. Primary ROTEM exposure variables were coagulation kinetics and clot strength assessments. Poor long-term outcome was defined as modified Rankin Scale ≥ 4 at 6 months. Logistic regression analyses assessed associations of ROTEM parameters with clinical outcomes after adjusting for ICH severity and hemoglobin concentration. Results: Of 44 patients analyzed, mean age was 64, 57% were female, and the median ICH volume was 23 mL. Poor 6-month outcome was seen in 64%. In our multivariable regression models, slower, prolonged coagulation kinetics (adjusted OR for every second increase in clot formation time: 1.04, 95% CI: 1.00-1.09, p = 0.04) and weaker clot strength (adjusted OR for every millimeter increase of maximum clot firmness: 0.84, 95% CI: 0.71-0.99, p = 0.03) were separately associated with poor long-term outcomes. Conclusions: Slower, prolonged coagulation kinetics and weaker clot strength on admission VHA ROTEM testing, not attributable to anticoagulant use, were associated with poor long-term outcomes after ICH. Further work is needed to clarify the generalizability and the underlying mechanisms of these VHA findings to assess whether VHA guided treatments should be incorporated into ICH care.
Language	English
Publishing date	2024-03-29
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-4087284/v1
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