• Julianne Murphy, Juliana Silva Pinheiro do Nascimento, Ethan J Houskamp, Hanyin Wang, Meghan Hutch, Yuzhe Liu, Roland Faigle, and Andrew M Naidech.
• Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, 633 N St. Clair St. 20th floor, Chicago, IL, USA. julianne.murphy@northwestern.edu.
• Neurocrit Care. 2024 Aug 6.

BackgroundThe objective of this study was to define clinically meaningful phenotypes of intracerebral hemorrhage (ICH) using machine learning.MethodsWe used patient data from two US medical centers and the Antihypertensive Treatment of Acute Cerebral Hemorrhage-II clinical trial. We used k-prototypes to partition patient admission data. We then used silhouette method calculations and elbow method heuristics to optimize the clusters. Associations between phenotypes, complications (e.g., seizures), and functional outcomes were assessed using the Kruskal-Wallis H-test or χ2 test.ResultsThere were 916 patients; the mean age was 63.8 ± 14.1 years, and 426 patients were female (46.5%). Three distinct clinical phenotypes emerged: patients with small hematomas, elevated blood pressure, and Glasgow Coma Scale scores > 12 (n = 141, 26.6%); patients with hematoma expansion and elevated international normalized ratio (n = 204, 38.4%); and patients with median hematoma volumes of 24 (interquartile range 8.2-59.5) mL, who were more frequently Black or African American, and who were likely to have intraventricular hemorrhage (n = 186, 35.0%). There were associations between clinical phenotype and seizure (P = 0.024), length of stay (P = 0.001), discharge disposition (P < 0.001), and death or disability (modified Rankin Scale scores 4-6) at 3-months' follow-up (P < 0.001). We reproduced these three clinical phenotypes of ICH in an independent cohort (n = 385) for external validation.ConclusionsMachine learning identified three phenotypes of ICH that are clinically significant, associated with patient complications, and associated with functional outcomes. Cerebellar hematomas are an additional phenotype underrepresented in our data sources.© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

4 keywords...

hide…