Intraventricular hemorrhage expansion in patients with spontaneous intracerebral hemorrhage
Intraventricular hemorrhage expansion in patients with spontaneous intracerebral hemorrhage
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DOI：
10.1212/wnl.0000000000001344
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发表时间：
2015-03-10
期刊：
影响因子：
9.9
通讯作者：
Claassen, Jan
中科院分区：
文献类型：
--
作者：
Witsch, Jens;Bruce, Eliza;Claassen, Jan
目的：评估延迟出现的脑室内出血（dIVH）是否代表入院CT上存在的脑室内出血（IVH）的独立实体，或主要与症状发作和入院CT之间的时间间隔有关。共282例自发性脑出血（ICH）患者，2009年2月至2014年3月在一所三级护理大学医院的神经重症监护室住院，前瞻性入组ICH结局项目。采用多因素logistic回归分析确定急性死亡率和功能性长期结局（改良兰金量表）之间的相关性。结果：回顾性研究了282例ICH患者的队列：151例（53.5%）在初始CT扫描（iIVH）时出现脑室内出血。其余131例患者中，19例（14.5%）在初次CT扫描（dIVH）后发生IVH。dIVH、iIVH和无IVH组从症状发作到入院CT的中位时间分别为1.1、6.0和7.4小时（Mann-Whitney U检验，dIVH vs iIVH，p < 0.001），从发作到dIVH检测的中位时间为7.2小时。dIVH患者入院后ICH体积的增加大于iIVH和无IVH患者（平均17.6、0.2和0.4 mL）。在控制了ICH评分和血肿扩张的成分后，初始CT上IVH的存在与出院死亡率和3、6和12个月的不良结局相关，但dIVH与任何结局指标无关。结论：在ICH患者中，入院时影像学检查发现的相关IVH常见，且与不良长期结局相关。相比之下，dIVH在随后的扫描中远不常见，似乎并不预示着更糟糕的结果。
Objective: To evaluate whether delayed appearance of intraventricular hemorrhage (dIVH) represents an independent entity from intraventricular hemorrhage (IVH) present on admission CT or is primarily related to the time interval between symptom onset and admission CT.Methods: A total of 282 spontaneous intracerebral hemorrhage (ICH) patients, admitted February 2009-March 2014 to the neurological intensive care unit of a tertiary care university hospital, were prospectively enrolled in the ICH Outcomes Project. Multivariate logistic regression was used to determine associations with acute mortality and functional long-term outcome (modified Rankin Scale).Results: A cohort of 282 ICH patients was retrospectively studied: 151 (53.5%) had intraventricular hemorrhage on initial CT scan (iIVH). Of the remaining 131 patients, 19 (14.5%) developed IVH after the initial CT scan (dIVH). The median times from symptom onset to admission CT were 1.1, 6.0, and 7.4 hours for the dIVH, iIVH, and no IVH groups (Mann-Whitney U test, dIVH vs iIVH, p < 0.001) and median time from onset to dIVH detection was 7.2 hours. The increase in ICH volume following hospital admission was larger in dIVH than in iIVH and no IVH patients (mean 17.6, 0.2, and 0.4 mL). After controlling for components of the ICH score and hematoma expansion, presence of IVH on initial CT was associated with discharge mortality and poor outcome at 3, 6, and 12 months, but dIVH was not associated with any of the outcome measures.Conclusions: In ICH patients, associated IVH on admission imaging is commonly encountered and is associated with poor long-term outcome. In contrast, dIVH on subsequent scans is far less common and does not appear to portend worse outcome.