Rate of stroke recurrence in patients with primary intracerebral hemorrhage
Rate of stroke recurrence in patients with primary intracerebral hemorrhage
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DOI：
10.1161/01.str.31.1.123
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发表时间：
2000-01-01
期刊：
影响因子：
8.3
通讯作者：
Tu, JV
中科院分区：
文献类型：
--
作者：
Hill, MD;Silver, FL;Tu, JV
原发性脑出血（PICH）是一种早期死亡率高的毁灭性疾病。高血压是缺血性脑血管病和颅内出血的主要危险因素。PICH的幸存者有复发性出血和缺血性脑血管病的风险。我们试图确定在加拿大多伦多的多伦多医院的一组PICH患者中ICH或脑缺血的复发率。方法：对1986年至1996年出院诊断为脑出血的患者的计算机化医院记录进行回顾性检索（国际疾病分类，第九修订版-临床修订版[ICD-9-CM]代码431），以确定索引病例。提取人口统计学和临床特征图表。审查了CT扫描、MR扫描或放射科医生报告。为了确定复发率，将数据库与安大略省政府生命统计登记处和加拿大卫生信息研究所出院摘要数据库相关联。Logistic回归分析用于确定PICH后死亡率的预测因素。一个考克斯比例风险模型拟合，以确定复发性ICH或stroke.Results-A的预测因素，共746图表确定了计算机搜索。抽取后，确定了423例PICH患者。其中，27.4%的患者在入院的前30天内死亡。死亡的预测因素是年龄、脑室内出血破裂和三叶出血。PICH的复发率为每年2.4%（95%CI 1.4%至3.9%），而缺血性脑血管病的复发率为每年3.0%（95%CI 1.8%至4.7%）。脑出血再入院的唯一重要预测因素是指征出血的脑叶位置，危险比为3.8（95%CI 1.2至12.0）。结论-PICH有很高的30天死亡率，从最初的损伤生存预示着中度复发风险，PICH每年为2.4%，缺血性脑血管病每年为3.0%。PICH患者存在缺血性卒中或TIA和复发性出血的风险;因此，PICH可能是缺血性卒中的标志物。脑叶出血患者再发ICH的风险增加3.8倍。
Background and Purpose-Primary intracerebral hemorrhage (PICH) is a devastating illness with high early mortality. Hypertension is a major risk factor both for ischemic cerebrovascular disease and for intracranial hemorrhage. Survivors of PICH are at risk for both recurrent hemorrhage and ischemic cerebrovascular disease. We sought to determine the rate of recurrence of ICH or cerebral ischemia in a cohort of PICH patients at the Toronto Hospital, Toronto, Canada.Methods-A retrospective search of computerized hospital records from 1986 to 1996 for patients with a discharge diagnosis of intracerebral hemorrhage (International Classification of Diseases, Ninth Revision-Clinical Modification [ICD-9-CM] code 431) was conducted to identify the index cases. Charts were abstracted for demographic and clinical characteristics. CT scans, MR scans, or radiologist reports were reviewed. To determine recurrence, the database was linked to the Ontario Provincial Government Vital Statistics Registry and to the Canadian Institute for Health Information database of hospital discharge abstracts. Logistic regression analysis was used to identify predictive factors for mortality after PICH. A Cox proportional hazards model was fitted to identify predictive factors for recurrent ICH or stroke.Results-A total of 746 charts were identified by computer search. After abstraction, 423 index patients with PICH were identified. Of these, 27.4% died in the first 30 days of their admission. Predictors of death were age, intraventricular rupture of hemorrhage, and trilobar hemorrhage. The recurrence rate for PICH was 2.4% (95% CI 1.4% to 3.9%) per year, whereas the recurrence rate for ischemic cerebrovascular disease was 3.0% (95% CI 1.8% to 4.7%) per year. The only significant predictor of readmission for ICH was lobar location of the index hemorrhage, with a hazard ratio of 3.8 (95% CI 1.2 to 12.0).Conclusions-PICH has a high 30-day mortality rate, Survival from the initial insult portends a moderate risk of recurrence of 2.4% per year for PICH and 3.0% per year for ischemic cerebrovascular disease. Patients with PICH are at risk for both ischemic stroke or TIA and recurrent hemorrhage; thus, PICH may be a marker for ischemic stroke. Patients with lobar hemorrhage have a 3.8-fold increased risk of recurrent ICH.