Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage
Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage
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DOI：
10.1212/01.wnl.0000208408.98482.99
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发表时间：
2006-04-25
期刊：
影响因子：
9.9
通讯作者：
Steiner, T
中科院分区：
文献类型：
--
作者：
Davis, SM;Broderick, J;Steiner, T
背景：尽管脑出血（ICH）的体积是死亡率的预测指标，但尚不清楚随后的血肿生长是否进一步增加了死亡的风险或功能不良。方法：为了确定血肿的生长是否独立预测结果，作者对自发ICH患者进行了单独的荟萃分析，这些患者在发作和24小时随访后3小时内患有CT。从三项试验中汇总了安慰剂患者，这些试验研究了RFVIIA的给药，安全性和功效（n = 115）和辛辛那提研究的103名患者（总计218）。其他基线因素包括年龄，性别，血糖，血压，格拉斯哥昏迷评分（GCS），脑室内出血（IVH）和位置。结果：总体而言，有72.9％的患者表现出一定程度的血肿生长。血肿增长百分比（危险比[HR] 1.05每10％增加[95％CI：1.03，1.08; P <0.0001]），初始ICH量（HR 1.01 / ml [95％CI：1.00：1.00，1.02; p = 0.003] ），GCS（HR 0.88 [95％CI：0.81，0.96; P = 0.003]）和IVH（ HR 2.23 [95％CI：1.25，3.98; p = 0.007]均与死亡率增加有关。增长百分比（累积或0.84 [95％CI：0.75，0.92; p <0.0001]），初始ICH体积（累积或0.94 [95％CI：0.91，0.97; p <0.0001]），GCS（累积或1.46 [95 [95] ％CI：1.21，1.82; p <0.0001）和年龄（累积或0.95 CI：0.92，0.98; p = 0.0009]）预测结果修改了Rankin量表。性别，位置，血糖和血压无法预测结果。结论：血肿的生长是脑出血后死亡率和功能结果的独立决定因素。增长的衰减是一项重要的治疗策略。
Background: Although volume of intracerebral hemorrhage (ICH) is a predictor of mortality, it is unknown whether subsequent hematoma growth further increases the risk of death or poor functional outcome. Methods: To determine if hematoma growth independently predicts poor outcome, the authors performed an individual meta-analysis of patients with spontaneous ICH who had CT within 3 hours of onset and 24-hour follow-up. Placebo patients were pooled from three trials investigating dosing, safety, and efficacy of rFVIIa (n = 115), and 103 patients from the Cincinnati study (total 218). Other baseline factors included age, gender, blood glucose, blood pressure, Glasgow Coma Score (GCS), intraventricular hemorrhage (IVH), and location. Results: Overall, 72.9% of patients exhibited some degree of hematoma growth. Percentage hematoma growth (hazard ratio [HR] 1.05 per 10% increase [95% CI: 1.03, 1.08; p < 0.0001]), initial ICH volume ( HR 1.01 per mL [95% CI: 1.00, 1.02; p = 0.003]), GCS ( HR 0.88 [ 95% CI: 0.81, 0.96; p = 0.003]), and IVH ( HR 2.23 [ 95% CI: 1.25, 3.98; p = 0.007]) were all associated with increased mortality. Percentage growth (cumulative OR 0.84 [95% CI: 0.75, 0.92; p < 0.0001]), initial ICH volume (cumulative OR 0.94 [95% CI: 0.91, 0.97; p < 0.0001]), GCS (cumulative OR 1.46 [95% CI: 1.21, 1.82; p < 0.0001]), and age ( cumulative OR 0.95 [95% CI: 0.92, 0.98; p = 0.0009]) predicted outcome modified Rankin Scale. Gender, location, blood glucose, and blood pressure did not predict outcomes. Conclusions: Hematoma growth is an independent determinant of both mortality and functional outcome after intracerebral hemorrhage. Attenuation of growth is an important therapeutic strategy.