Blend Sign Predict Hematoma Enlargement And Poor Prognosis In Patients After Intracerebral Hemorrhage:a Systematic Review And Meta-Analysis

Background: Early hematoma enlargement(HE)occurs in patients with intracranial hemorrhage(ICH)in the first few hours after the onset of ICH.Hematoma enlargement has been considered as an independent predictor of poor clinical prognosis and high mortality after intracranial hemorrhage.It is reported that the Blend Sign(BS)on non-contrast computed tomography(NCCT)is associated with hematoma enlargement.The Blend Sign seems to increase the detection rate of enlarged hematoma.However,there is not enough evidence to show that BS is an independent predictor of prognosis and HE in patients with ICH.We conducted a meta-analysis to investigate the accuracy of Blend Sign in predicting HE and poor prognosis.Objectives: To explore whether BS on NCCT can predict HE and functional prognosis after ICH.Methods: The system searches the main databases,including Pub Med,Embase,Web of Science,Cochrane Library and Chinese databases(CNKI,VIP and Wan fang databases).Including studies on the relationship between BS and HE or BS and functional prognosis.The combined results use the ratio(OR)and 95% confidence interval(CI)as the effect size.Heterogeneity and publication bias were assessed.When the heterogeneity was large,subgroup analysis and Meta regression were used to detect potential heterogeneity factors.Results: The meta-analysis retrieved a total of 393 articles based on the inclusion and exclusion criteria,and after further screening through the inclusion and exclusion criteria,a total of 12 studies were finally aggregated,involving 4,712 patients.The ideal time to evaluate HE is not uniform or standardized.We conducted two meta-analyses respectively.First,11 studies were used to estimate the association between BS and HE,and the combined OR was statistically significant(OR =5.07,95%CI=4.27-6.02,P < 0.001).Secondly the meta-analysis included three studies and the results showed that there was a significant positive correlation between BS and poor prognosis(OR = 5.06,95%CI = 3.13-8.20 P < 0.001).Conclusions:This meta-analysis of blend sign shows that:1.blend sign on non-contrast computed tomography can predict the risk of hematoma enlargement after spontaneous intracerebral hemorrhage.2.The blend sign can predict the risk of poor prognosis and has potential predictive value.PROSPERO Registration number:The protocol has been registered in the PROSPERO network under the serial number CRD42020222228.