SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage - PubMed (original) (raw)
. 2012 Oct;43(10):2592-7.
doi: 10.1161/STROKEAHA.112.661603. Epub 2012 Aug 2.
Daniel Strbian, Jukka Putaala, Sami Curtze, Elena Haapaniemi, Satu Mustanoja, Tiina Sairanen, Jarno Satopää, Heli Silvennoinen, Mika Niemelä, Markku Kaste, Turgut Tatlisumak
Affiliations
- PMID: 22858729
- DOI: 10.1161/STROKEAHA.112.661603
SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage
Atte Meretoja et al. Stroke. 2012 Oct.
Abstract
Background and purpose: The purpose of this study was to provide a simple and practical clinical classification for the etiology of intracerebral hemorrhage (ICH).
Methods: We performed a retrospective chart review of consecutive patients with ICH treated at the Helsinki University Central Hospital, January 2005 to March 2010 (n=1013). We classified ICH etiology by predefined criteria as structural vascular lesions (S), medication (M), amyloid angiopathy (A), systemic disease (S), hypertension (H), or undetermined (U). Clinical and radiological features and mortality by SMASH-U (Structural lesion, Medication, Amyloid angiopathy, Systemic/other disease, Hypertension, Undetermined) etiology were analyzed.
Results: Structural lesions, namely cavernomas and arteriovenous malformations, caused 5% of the ICH, anticoagulation 14%, and systemic disease 5% (23 liver cirrhosis, 8 thrombocytopenia, and 17 various rare conditions). Amyloid angiopathy (20%) and hypertensive angiopathy (35%) were common, but etiology remained undetermined in 21%. Interrater agreement in classifying cases was high (κ, 0.89; 95% CI, 0.82-0.96). Patients with structural lesions had the smallest hemorrhages (median volume, 2.8 mL) and best prognosis (3-month mortality 4%), whereas anticoagulation-related ICHs were largest (13.4 mL) and most often fatal (54%). Overall, median ICH survival was 5½ years, varying strongly by etiology (P<0.001). After adjustment for baseline characteristics, patients with structural lesions had the lowest 3-month mortality rates (OR, 0.06; 95% CI, 0.01-0.37) and those with anticoagulation (OR, 1.9; 1.0-3.6) or other systemic cause (OR, 4.0; 1.6-10.1) the highest.
Conclusions: In our patients, performing the SMASH-U classification was feasible and interrater agreement excellent. A plausible etiology was determined in most patients but remained elusive in one in 5. In this series, SMASH-U based etiology was strongly associated with survival.
Similar articles
- Pathogenetical subtypes of recurrent intracerebral hemorrhage: designations by SMASH-U classification system.
Yeh SJ, Tang SC, Tsai LK, Jeng JS. Yeh SJ, et al. Stroke. 2014 Sep;45(9):2636-42. doi: 10.1161/STROKEAHA.114.005598. Epub 2014 Jul 22. Stroke. 2014. PMID: 25052320 - The etiologic subtype of intracerebral hemorrhage may influence the risk of significant hematoma expansion.
Cappellari M, Zivelonghi C, Moretto G, Micheletti N, Carletti M, Tomelleri G, Bovi P. Cappellari M, et al. J Neurol Sci. 2015 Dec 15;359(1-2):293-7. doi: 10.1016/j.jns.2015.11.024. Epub 2015 Nov 14. J Neurol Sci. 2015. PMID: 26671130 - Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study.
Zhang S, Wang Z, Zheng A, Yuan R, Shu Y, Zhang S, Lei P, Wu B, Liu M. Zhang S, et al. J Am Heart Assoc. 2020 Oct 20;9(19):e016766. doi: 10.1161/JAHA.120.016766. Epub 2020 Sep 13. J Am Heart Assoc. 2020. PMID: 32924756 Free PMC article. - Cerebral amyloid angiopathy-associated intracerebral hemorrhage: pathology and management.
Mehndiratta P, Manjila S, Ostergard T, Eisele S, Cohen ML, Sila C, Selman WR. Mehndiratta P, et al. Neurosurg Focus. 2012 Apr;32(4):E7. doi: 10.3171/2012.1.FOCUS11370. Neurosurg Focus. 2012. PMID: 22463117 Review. - Management of Intracerebral Hemorrhage: JACC Focus Seminar.
Schrag M, Kirshner H. Schrag M, et al. J Am Coll Cardiol. 2020 Apr 21;75(15):1819-1831. doi: 10.1016/j.jacc.2019.10.066. J Am Coll Cardiol. 2020. PMID: 32299594 Review.
Cited by
- Heart Rate Variability and Functional Outcomes of Patients with Spontaneous Intracerebral Hemorrhage.
Laichinger K, Mengel A, Buesink R, Roesch S, Stefanou MI, Single C, Hauser TK, Krumbholz M, Ziemann U, Feil K. Laichinger K, et al. Biomedicines. 2024 Aug 16;12(8):1877. doi: 10.3390/biomedicines12081877. Biomedicines. 2024. PMID: 39200341 Free PMC article. - Phenotypes of Patients with Intracerebral Hemorrhage, Complications, and Outcomes.
Murphy J, Silva Pinheiro do Nascimento J, Houskamp EJ, Wang H, Hutch M, Liu Y, Faigle R, Naidech AM. Murphy J, et al. Neurocrit Care. 2024 Aug 6. doi: 10.1007/s12028-024-02067-2. Online ahead of print. Neurocrit Care. 2024. PMID: 39107659 - A Small Step Toward Rational Characterization of Intracerebral Hemorrhage Phenotypes.
Williamson CA. Williamson CA. Neurocrit Care. 2024 Aug 6. doi: 10.1007/s12028-024-02069-0. Online ahead of print. Neurocrit Care. 2024. PMID: 39107658 No abstract available. - Premorbid Blood Pressure Control Modifies Risk of DWI Lesions With Acute Blood Pressure Reduction in Intracerebral Hemorrhage.
Ridha M, Hannawi Y, Murthy S, Carvalho Poyraz F, Kumar A, Park S, Roh D, Sekar P, Woo D, Burke J. Ridha M, et al. Hypertension. 2024 Oct;81(10):2113-2123. doi: 10.1161/HYPERTENSIONAHA.124.23271. Epub 2024 Jul 29. Hypertension. 2024. PMID: 39069917 - Baseline perihematomal edema, C-reactive protein, and 30-day mortality are not associated in intracerebral hemorrhage.
Sobowale OA, Hostettler IC, Wu TY, Heal C, Wilson D, Shah DG, Strbian D, Putaala J, Tatlisumak T, Vail A, Sharma G, Davis SM, Werring DJ, Meretoja A, Allan SM, Parry-Jones AR. Sobowale OA, et al. Front Neurol. 2024 Apr 5;15:1359760. doi: 10.3389/fneur.2024.1359760. eCollection 2024. Front Neurol. 2024. PMID: 38645743 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources