Rate of Perihematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage.
Rate of Perihematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage.
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DOI：
10.1097/ccm.0000000000001553
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发表时间：
2016-04
影响因子：
8.8
通讯作者：
Sheth KN
中科院分区：
文献类型：
--
作者：
Urday S;Beslow LA;Dai F;Zhang F;Battey TW;Vashkevich A;Ayres AM;Leasure AC;Selim MH;Simard JM;Rosand J;Kimberly WT;Sheth KN
脑出血（ICH）是一种目前尚无治疗方法的破坏性疾病。血肿周围水肿（PHE）是否是神经系统结局的独立预测因子仍有争议。我们试图确定PHE扩张率是否能预测ICH后的结局。回顾性队列研究三级医疗中心139例连续幕上自发性ICH患者，年龄>18岁，2000-2013年住院。根据就诊时、ICH后24小时和72小时获得的计算机断层扫描（CT）测量无ICH、脑室内出血（IVH）和PHE体积。PHE扩张率是初始和随访PHE体积之间的差异除以时间间隔。进行Logistic回归以评价1）24小时PHE扩张率与90天死亡率之间的关系，以及2）24小时PHE扩张率与90天改良兰金量表评分（mRS）之间的关系。从入院到ICH后24小时的PHE扩张率是90天死亡率的重要预测因子（OR 2.97，95%CI 1.48-5.99，p=0.002）。在调整ICH评分的所有组成部分后，这种相关性仍然存在（OR 2.21，95% CI 1.05-4.64，p=0.04）。同样，在顺序变化分析中，较高的24小时PHE扩张率与较差的mRS相关（OR 2.40，95% CI 1.37-4.21，p= 0.002），即使在调整所有ICH评分组分后（OR 2.07，95% CI 1.12-3.83，p=0.02）。ICH后24小时内PHE扩张速度加快与预后较差相关。PHE可能是ICH后继发性损伤的一个有吸引力的翻译靶点。
Intracerebral hemorrhage (ICH) is a devastating disorder with no current treatment. Whether peri-hematomal edema (PHE) is an independent predictor of neurologic outcome is controversial. We sought to determine whether PHE expansion rate predicts outcome after ICH. Retrospective cohort study Tertiary medical center 139 consecutive supratentorial spontaneous ICH patients >18 years admitted between 2000–2013. None ICH, intraventricular hemorrhage (IVH), and PHE volumes were measured from computed tomography (CT) scans obtained at presentation, 24 hours, and 72 hours post-ICH. PHE expansion rate was the difference between initial and follow-up PHE volumes divided by the time interval. Logistic regression was performed to evaluate the relationship between 1) PHE expansion rate at 24 hours and 90-day mortality and 2) PHE expansion rate at 24 hours and 90-day modified Rankin Scale score (mRS). PHE expansion rate between admission and 24-hours post-ICH was a significant predictor of 90-day mortality (OR 2.97, 95%CI 1.48–5.99, p=0.002). This association persisted after adjusting for all components of the ICH score (OR 2.21, 95% CI 1.05–4.64, p=0.04). Similarly, higher 24-hour PHE expansion rate was associated with poorer mRS in an ordinal shift analysis (OR 2.40, 95% CI 1.37–4.21, p=.002), even after adjustment for all ICH score components (OR 2.07, 95% CI 1.12–3.83, p=0.02). Faster PHE expansion rate 24 hours post-ICH is associated with worse outcome. PHE may represent an attractive translational target for secondary injury after ICH.