Long-term functional decline of spontaneous intracerebral haemorrhage survivors
Long-term functional decline of spontaneous intracerebral haemorrhage survivors
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DOI：
10.1136/jnnp-2020-324741
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发表时间：
2021-03-01
影响因子：
11
通讯作者：
Cordonnier, Charlotte
中科院分区：
文献类型：
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作者：
Pasi, Marco;Casolla, Barbara;Cordonnier, Charlotte
目的确定自发性脑出血(ICH)后存活6个月的患者的基线特征和与功能衰退相关的新的临床事件。方法在一项单中心研究中，我们前瞻性地纳入了改良Rankin评分(MRS)0-3分的6个月幸存者。我们通过过渡到MRS 4-5来定义功能性衰退。我们使用单变量和多变量模型评估基线特征和新的临床事件与功能下降的相关性。结果560名患者中，174名(31%)在6个月时MRS评分为0-3。中位随访9年(IQR8.1-9.5)，40例(23%)转为MRS 4-5。年龄、糖尿病、脑出血量和6个月时较高的MRS评分与功能下降独立相关。在基线MRI标记物中，存在严格的大叶脑微出血(CMBS)，以及混合大叶和深部CMBS与功能下降独立相关。当在多变量模型中加入随访期间发生的新临床事件时，年龄(病因特异性心率(CSHR)：1.07；95%CI：1.03至1.11)、脑出血量(CSHR：1.03；(95%CI：1.01~1.06)、6个月的MRS评分(CSHR每1分增加1.61分，95%CI为1.07~2.43分)、痴呆的发生(CSHR：3.81，95%CI：1.78~8.16)和任何中风的发生(CSHR：4.29，95%CI：1.80~10.22)仍与向MRS 4-5的转变独立相关。年龄、脑出血量、6个月时较高的MRS评分和脑出血后新的临床事件是主要的决定因素。
Objective To identify in patients who survived 6 months after a spontaneous intracerebral haemorrhage (ICH) baseline characteristics and new clinical events associated with functional decline.Methods In a single-centre study, we prospectively included 6-month survivors with a modified Rankin Scale (mRS) score 0-3. We defined functional decline by a transition to mRS 4-5. We evaluated associations of baseline characteristics and new clinical events with functional decline, using univariate and multivariable models.Results Of 560 patients, 174 (31%) had an mRS score 0-3 at 6 months. During a median follow-up of 9 years (IQR 8.1-9.5), 40 (23%) converted to mRS 4-5. Age, diabetes mellitus, ICH volume and higher mRS scores at 6 months were independently associated with functional decline. Among baseline MRI markers, presence of strictly lobar cerebral microbleeds (CMBs), and mixed lobar and deep CMBs were independently associated with functional decline. When new clinical events occurring during follow-up were added in multivariable models, age (cause-specific HR (CSHR): 1.07; 95% CI: 1.03 to 1.11), ICH volume (CSHR: 1.03; 95% CI: 1.01 to 1.06), mRS score at 6 months (CSHR per 1 point increase 1.61, 95% CI 1.07 to 2.43), occurrence of dementia (CSHR: 3.81, 95% CI: 1.78 to 8.16) and occurrence of any stroke (CSHR: 4.29, 95% CI: 1.80 to 10.22) remained independently associated with transition to mRS 4-5.Interpretation Almost one-fourth of patients with spontaneous ICH developed a functional decline over time. Age, ICH volume, higher mRS score at 6 months and new clinical events after ICH are the major determinants.