Impact of Cerebral Small Vessel Disease on Functional Recovery After Intracerebral Hemorrhage
Impact of Cerebral Small Vessel Disease on Functional Recovery After Intracerebral Hemorrhage
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DOI：
10.1161/strokeaha.119.025061
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发表时间：
2019-10-01
期刊：
影响因子：
8.3
通讯作者：
Rosand, Jonathan
中科院分区：
文献类型：
--
作者：
Venema, Simone M. Uniken;Marini, Sandro;Rosand, Jonathan
背景和目的——在本研究中，我们旨在调查基于计算机断层扫描的脑小血管疾病标志物与脑出血后功能结果和恢复的关系。方法——使用视觉评分量表评估 ERICH 研究（脑出血的种族和种族变异）中患者的计算机断层扫描扫描，以评估脑白质疏松和脑萎缩的程度。较差的功能结果被定义为改良等级量表 (mRS) >= 3。使用多变量逻辑回归和线性回归模型来探索脑小血管疾病成像标志物与出院时较差的功能结果之间的关联，并作为恢复的衡量标准，从出院到中风后 90 天的 mRS 变化。结果 - 在排除院内死亡后，数据来自 2344 名患者，其中 583 名 (24.9%) 具有良好的功能结果（mRS 为包括 1761 名（75.1%）出院时功能结果不佳（mRS 为 3-5）的患者。脑白质疏松程度的增加（趋势 P，0.01）和仅严重（4 级）整体萎缩（比值比，2.02；95% CI，1.22-3.39，P=0.007）与出院时功能不良结果独立相关。从出院到 90 天随访的平均 (SD) mRS 变化为 0.57 (1.18)。脑白质疏松程度的增加（趋势 P，0.002）和严重的整体萎缩（β [SE]，-0.23 [0.115]；P=0.045）与出院至中风后 90 天 mRS 改善较小独立相关。结论 - 在脑出血幸存者中，脑出血时脑小血管疾病的程度与出院时功能不良结果相关从出院到中风后 90 天的功能恢复受损。
Background and Purpose-In this study, we aim to investigate the association of computed tomography-based markers of cerebral small vessel disease with functional outcome and recovery after intracerebral hemorrhage.Methods-Computed tomographic scans of patients in the ERICH study (Ethnic and Racial Variations of Intracerebral Hemorrhage) were evaluated for the extent of leukoaraiosis and cerebral atrophy using visual rating scales. Poor functional outcome was defined as a modified Rank in Scale (mRS) of >= 3. Multivariable logistic and linear regression models were used to explore the associations of cerebral small vessel disease imaging markers with poor functional outcome at discharge and, as a measure of recovery, change in mRS from discharge to 90 days poststroke.Results-After excluding in-hospital deaths, data from 2344 patients, 583 (24.9%) with good functional outcome (mRS of 0-2) at discharge and 1761 (75.1%) with poor functional outcome (mRS of 3-5) at discharge, were included. Increasing extent of leukoaraiosis (P for trend, 0.01) and only severe (grade 4) global atrophy (odds ratio, 2.02; 95% CI, 1.22-3.39, P=0.007) were independently associated with poor functional outcome at discharge. Mean (SD) mRS change from discharge to 90-day follow-up was 0.57 (1.18). Increasing extent of leukoaraiosis (P for trend, 0.002) and severe global atrophy (beta [SE], -0.23 [0.115]; P=0.045) were independently associated with less improvement in mRS from discharge to 90 days poststroke.Conclusions-In intracerebral hemorrhage survivors, the extent of cerebral small vessel disease at the time of intracerebral hemorrhage is associated with poor functional outcome at hospital discharge and impaired functional recovery from discharge to 90 days poststroke.