Hematoma Expansion Predictors: Laboratory and Radiological Risk Factors in Patients with Acute Intracerebral Hemorrhage: A Prospective Observational Study
Hematoma Expansion Predictors: Laboratory and Radiological Risk Factors in Patients with Acute Intracerebral Hemorrhage: A Prospective Observational Study
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DOI：
10.1016/j.jstrokecerebrovasdis.2019.04.038
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发表时间：
2019-08-01
影响因子：
2.5
通讯作者：
Bessar, Ahmad Awad
中科院分区：
文献类型：
--
作者：
Elkhatib, Takwa H. M.;Shehta, Nahed;Bessar, Ahmad Awad
背景：脑出血是一种严重的神经系统急症，发病率和死亡率较高。早期血肿扩大（HE）被认为是ICH后预后不良的因素之一。因此，确定HE的可能风险因素可以有效地早期发现高危患者，从而指导旨在改善ICH结局的管理过程。方法：纳入136例自发性ICH患者，并前瞻性评估HE的存在。研究了人口统计学、实验室检查和某些放射学因素，并比较了有HE和无HE的患者，同时评估了住院死亡率。结果如下：在30%的研究队列中观察到HE，与未发生HE的患者相比，发生HE的患者有更多的神经功能缺损（格拉斯哥昏迷量表，中位数9;国家卫生研究所卒中量表，中位数34）和更高的住院死亡率（53.6%）。HE与存在较高的红细胞分布宽度（RDW）、降低的总胆固醇、低密度脂蛋白-C（LDL-C）和Ca水平相关。在影像学因素中，血肿密度（不均匀）和形状（不规则）与HE的发生高度相关。脑出血患者的CT血管造影（CTA）斑点征与HE的发生相关。结论：RDW异常;低胆固醇、低密度脂蛋白、低钙水平、密度不均、不规则出血和CTA斑点征的出现与自发性脑出血中HE的发生有关。
Background: Intracerebral hemorrhage (ICH) is considered a devastating neurologic emergency and carried a higher morbidity and mortality rates. Early hematoma expansion (HE) is considered one of the poor prognostic factors after ICH. Consequently, determination of the possible risk factors for HE could be effective in early detection of high-risk patients and hence directing management course aiming to improving ICH outcome. Methods: One-hundred and thirty-six spontaneous ICH patients were included and prospectively evaluated for the presence of HE. Demographic, laboratory, and certain radiological factors were studied and compared between those with HE and those without, the in-hospital mortality rates were assessed as well. Results: HE was observed in 30% of the studied cohort, those who developed HE had more neurologic impairment (Glasgow coma scale, median 9; National Institute of Health Stroke Scale, median 34), and higher in-hospital mortality rate (53.6%) than those without HE. HE was related to the presence of higher red blood cell distribution width (RDW), reduced total cholesterol, low-density lipoprotein-C (LDL-C), and Ca levels. Among the radiological factors, hematoma density (heterogeneous), and shape (irregular) are highly related to the occurrence of HE. The computed tomography angiography (CTA) spot sign among patients with ICH was associated with HE development. Conclusions: Abnormal RDW; low cholesterol, LDL, and Ca level; heterogeneous density, irregular shape hemorrhage, and presence of CTA spot sign were associated with the development of HE in the setting of spontaneous ICH.