Anemia and hematoma volume in acute intracerebral hemorrhage
Anemia and hematoma volume in acute intracerebral hemorrhage
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DOI：
10.1097/ccm.0b013e31819ced3a
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发表时间：
2009-04-01
影响因子：
8.8
通讯作者：
Rosand, Jonathan
中科院分区：
文献类型：
--
作者：
Kumar, Monisha A.;Rost, Natalia S.;Rosand, Jonathan
目的：贫血增加危重病人出血并发症的风险。原发性脑出血（ICH）是最致命的中风类型，其结果在很大程度上取决于脑出血的量。探讨贫血与急性缺血性脑出血临床病程的关系。从一项正在进行的为期6年的非创伤性脑出血单中心前瞻性队列研究中，确定了694名连续受试者。贫血是根据世界卫生组织的标准定义的。研究终点为脑出血体积（通过基线计算机断层扫描测量）和30天死亡率。结果：177例（25.8%）患者入院时出现贫血。贫血患者年龄较大（p = 0.005），更容易患冠状动脉疾病（p < 0.0001）。在多变量分析中，贫血（p = 0.009）、脑出血大叶位置（p < 0.001）、白细胞计数（p < 0.001）和入院舒张压（p < 0.001）与脑出血体积增大有关。虽然在考虑脑出血体积后，在多变量分析中，这些变量都不是30天死亡率的重要预测因子，但贫血的优势比边际降低的大小表明，除了脑出血体积外，它可能通过其他机制对死亡率有很小的影响。贫血在急性脑出血中很常见，入院时贫血是脑出血容量较大的独立预测因子。鉴于脑出血体积在预后中的核心作用，阐明这种关系背后的机制可能为降低脑出血发病率和死亡率提供新的治疗靶点。（重症护理医学2009；37:1442-1447）
Objective: Anemia increases risk of bleeding complications in the critically ill. In primary intracerebral hemorrhage (ICH), the most fatal type of stroke, outcome is largely dependent on the volume of hemorrhage into the brain. We investigated the relationship between anemia and clinical course of acute ICH.Methods. Six hundred ninety-four consecutive subjects were identified from an ongoing single-center prospective cohort study of nontraumatic ICH during a 6-year period. Anemia was defined according to World Health Organization criteria. Study end points were ICH volume, as measured on the baseline computed tomography scan, and 30-day mortality.Results: Anemia was present in 177 (25.8%) patients on admission. Patients with anemia were older (p = 0.005) and more likely to have coronary artery disease (p < 0.0001). In multivariable analysis, anemia (p = 0.009), lobar location of ICH (p < 0.001), white blood cell count (p < 0.001), and admission diastolic blood pressure (p < 0.001) were associated with larger ICH volume. Although after accounting for ICH volume, none of these variables was a significant predictor of 30-day mortality in multivariable analysis, the size of the marginal reduction in the odds ratio for anemia suggests that it may have a small effect on mortality through mechanisms in addition to ICH volume.Conclusions. Anemia is common in acute ICH and its presence at admission is an independent predictor of larger volume of ICH. Given the central role of ICH volume in outcome, clarification of the mechanisms underlying this relationship may offer novel therapeutic targets for reducing ICH morbidity and mortality. (Crit Care Med 2009; 37:1442-1447)