SMASH-U A Proposal for Etiologic Classification of Intracerebral Hemorrhage
SMASH-U A Proposal for Etiologic Classification of Intracerebral Hemorrhage
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DOI：
10.1161/strokeaha.112.661603
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发表时间：
2012-10-01
期刊：
影响因子：
8.3
通讯作者：
Tatlisumak, Turgut
中科院分区：
文献类型：
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作者：
Meretoja, Atte;Strbian, Daniel;Tatlisumak, Turgut
背景和目的-本研究的目的是提供一个简单实用的临床分类的病因脑出血（ICH）的方法，我们进行了一个回顾性的图表审查连续的ICH患者在赫尔辛基大学中心医院，2005年1月至2010年3月（n=1013）。我们根据预先确定的标准将ICH病因分类为结构性血管病变（S）、药物治疗（M）、淀粉样血管病（A）、系统性疾病（S）、高血压（H）或未确定（U）。SMASH-U（结构性病变，药物治疗，淀粉样血管病，系统性/其他疾病，高血压，未确定）病因的临床和放射学特征和死亡率进行了analysed.Results-Structural病变，即海绵状血管瘤和动静脉畸形，引起ICH的5%，抗凝14%，和系统性疾病5%（23肝硬化，8血小板减少症，和17各种罕见的条件）。淀粉样血管病（20%）和高血压性血管病（35%）是常见的，但病因不明的21%。评估者对病例分类的一致性较高（kappa，0.89; 95%CI，0.82-0.96）。结构性病变患者的出血量最小（中位体积为2.8 mL），预后最好（3个月死亡率为4%），而抗凝相关ICH最大（13.4 mL），最常致死（54%）。总的来说，ICH的中位生存期为5.5年，不同病因差异很大（P
Background and Purpose-The purpose of this study was to provide a simple and practical clinical classification for the etiology of intracerebral hemorrhage (ICH).Methods-We performed a retrospective chart review of consecutive patients with ICH treated at the Helsinki University Central Hospital, January 2005 to March 2010 (n=1013). We classified ICH etiology by predefined criteria as structural vascular lesions (S), medication (M), amyloid angiopathy (A), systemic disease (S), hypertension (H), or undetermined (U). Clinical and radiological features and mortality by SMASH-U (Structural lesion, Medication, Amyloid angiopathy, Systemic/other disease, Hypertension, Undetermined) etiology were analyzed.Results-Structural lesions, namely cavernomas and arteriovenous malformations, caused 5% of the ICH, anticoagulation 14%, and systemic disease 5% (23 liver cirrhosis, 8 thrombocytopenia, and 17 various rare conditions). Amyloid angiopathy (20%) and hypertensive angiopathy (35%) were common, but etiology remained undetermined in 21%. Interrater agreement in classifying cases was high (kappa, 0.89; 95% CI, 0.82-0.96). Patients with structural lesions had the smallest hemorrhages (median volume, 2.8 mL) and best prognosis (3-month mortality 4%), whereas anticoagulation-related ICHs were largest (13.4 mL) and most often fatal (54%). Overall, median ICH survival was 51/2 years, varying strongly by etiology (P