Predicting hematoma expansion after primary intracerebral hemorrhage.
Predicting hematoma expansion after primary intracerebral hemorrhage.
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DOI：
10.1001/jamaneurol.2013.5433
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发表时间：
2014-02
期刊：
影响因子：
29
通讯作者：
Goldstein, Joshua N.
中科院分区：
文献类型：
--
作者：
Brouwers, H. Bart;Chang, Yuchiao;Falcone, Guido J.;Cai, Xuemei;Ayres, Alison M.;Battey, Thomas W. K.;Vashkevich, Anastasia;McNamara, Kristen A.;Valant, Valerie;Schwab, Kristin;Orzell, Susannah C.;Bresette, Linda M.;Feske, Steven K.;Rost, Natalia S.;Romero, Javier M.;Viswanathan, Anand;Chou, Sherry H. -Y.;Greenberg, Steven M.;Rosand, Jonathan;Goldstein, Joshua N.
许多临床试验的重点是限制急性脑出血（ICH）后的血肿扩大，但选择那些血肿扩大风险最高的患者具有挑战性。开发原发性ICH患者血肿扩展的预测评分。在2个城市学术医学中心进行的一项前瞻性队列研究，在具有可用基线和随访计算机断层扫描进行体积分析的原发性ICH患者中进行（开发队列中817例患者，独立验证队列中195例患者）。使用半自动软件评估血肿扩张，并将其定义为超过6 mL或33%的增长。使用单变量和多变量logistic回归检验协变量与血肿扩大的相关性。根据回归估计值得出9分预测评分，随后在独立验证队列中进行检验。血肿扩大156例（19.1%）。在多变量分析中，扩张的预测因素如下：华法林钠的使用，计算机断层扫描血管造影斑点征，计算机断层扫描时间较短（≤ 6 vs >6小时）（所有P <0.001），以及基线ICH体积（<30 [参考]，30-60 [P = 0.03]和>60 [P = 0.005] mL）。血肿扩大的发生率随着评分的升高而稳步增加。在独立验证队列（n = 195）中，我们的预测评分表现良好，并显示与血肿扩大有很强的相关性（比值比，4.59;高评分与低评分的P <0.001）。开发队列的评分的C统计量为0.72，独立验证队列为0.77。开发并独立验证了血肿扩展的9分预测评分。这些结果为ICH的个体化治疗和试验设计开辟了一条道路，旨在为血肿扩大风险最高的患者提供最大的治疗获益潜力。
Many clinical trials focus on restricting hematoma expansion following acute intracerebral hemorrhage (ICH), but selecting those patients at highest risk of hematoma expansion is challenging. To develop a prediction score for hematoma expansion in patients with primary ICH. Prospective cohort study at 2 urban academic medical centers among patients having primary ICH with available baseline and follow-up computed tomography for volumetric analysis (817 patients in the development cohort and 195 patients in the independent validation cohort). Hematoma expansion was assessed using semiautomated software and was defined as more than 6 mL or 33% growth. Covariates were tested for association with hematoma expansion using univariate and multivariable logistic regression. A 9-point prediction score was derived based on the regression estimates and was subsequently tested in the independent validation cohort. Hematoma expansion occurred in 156 patients (19.1%). In multivariable analysis, predictors of expansion were as follows: warfarin sodium use, the computed tomography angiography spot sign, and shorter time to computed tomography (≤ 6 vs >6 hours) (P <.001 for all), as well as baseline ICH volume (<30 [reference], 30–60 [P =.03], and >60 [P =.005] mL). The incidence of hematoma expansion steadily increased with higher scores. In the independent validation cohort (n = 195), our prediction score performed well and showed strong association with hematoma expansion (odds ratio, 4.59; P <.001 for a high vs low score). The C statistics for the score were 0.72 for the development cohort and 0.77 for the independent validation cohort. A 9-point prediction score for hematoma expansion was developed and independently validated. The results open a path for individualized treatment and trial design in ICH aimed at patients at highest risk of hematoma expansion with maximum potential for therapeutic benefit.
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影响因子：
37.8
作者：
Normand SL
通讯作者：
Normand SL
DOI：
10.1159/000346599
发表时间：
2013
期刊：
Cerebrovascular diseases (Basel, Switzerland)
影响因子：
--
作者：
Brouwers HB;Greenberg SM
通讯作者：
Greenberg SM
影响因子：
3.5
作者：
Qureshi AI;Palesch YY
通讯作者：
Palesch YY
影响因子：
8.3
作者：
Flaherty, ML;Woo, D;Broderick, JP
通讯作者：
Broderick, JP
影响因子：
158.5
作者：
Mayer, Stephan A.;Brun, Nikolai C.;Steiner, Thorsten
通讯作者：
Steiner, Thorsten