A reliable grading system for prediction of hematoma expansion in intracerebral hemorrhage in the basal ganglia
A reliable grading system for prediction of hematoma expansion in intracerebral hemorrhage in the basal ganglia
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DOI：
10.5582/bst.2018.01061
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发表时间：
2018-04-01
影响因子：
5.5
通讯作者：
Yang, Mingfei
中科院分区：
文献类型：
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作者：
Huang, Yongwei;Zhang, Qiang;Yang, Mingfei
血肿扩大（HE）是脑出血（ICH）预后不良和继发性神经功能恶化的独立预测因子，并与高发病率和死亡率相关。非对比计算机断层扫描（NCCT）可以识别活动性外渗部位。因此，我们尝试（1）设计一种可靠且易于使用的预测评分来预测ICH中HE的风险，（2）验证该分级系统的准确性，并对HE预测因子进行独立分析。我们纳入了2015年1月至2018年1月期间基底节发生脑出血（ICH）的患者。这些患者在ICH症状发作后24小时内在青海省人民医院接受了基线CT扫描。在患者选择期间，两名观察员独立评估NCCT扫描上是否存在岛状征、混合征或漩涡征。患者接受基线NCCT扫描和24小时NCCT随访，以分析HE。评估了该分级系统的准确性。使用多变量回归确定HE的独立预测因子。266例脑出血患者中，岛状征61例（22.93%），混合征63例（23.68%），漩涡征50例（18.80%）。HE的总发生率为37.22%（99/266）。在发病6小时内接受基线CT扫描的125例患者（46.99%）中，141例（53.01%）在6-24小时内接受扫描。多变量logistic回归分析确定了血肿体积（OR，0.974; P = 0.042），脑室内出血（IVH）扩展（OR，3.225; P = 0.003），从发作到基线CT扫描的时间（OR，0.986; P < 0.001），抗凝剂使用或国际标准化比值（INR）> 1.5（OR，3.362; P = 0.006）与HE密切相关。总之，分级系统在预测HE方面表现出可靠的准确性。该分级系统在一项独立的单机构研究中证明了可接受的准确性。分级系统在预测ICH患者HE和不良结局方面的作用是显著的。NCCT成像标记物可作为HE预测的关键标记物。
Hematoma expansion (HE) is an independent predictor of poor outcome and secondary neurological deterioration in intracerebral hemorrhage (ICH) and is associated with high morbidity and mortality. Noncontrast computed tomography (NCCT) may identify the sites of active extravasation. Therefore, we have attempted to (1) devise a reliable and easyto- use prediction score to predict the risk of HE in ICH and (2) validate the accuracy of this grading system and perform an independent analysis of HE predictors. We included patients in whom an intracerebral hemorrhage (ICH) occurred in the basal ganglia between Jan. 2015 and Jan. 2018. These patients had undergone a baseline CT scan at Qinghai Provincial People's Hospital within 24 hours after the onset of ICH symptoms. Two observers independently assessed the presence of the island sign, blend sign, or swirl sign on an NCCT scan during patient selection. Patients underwent a baseline NCCT scan and 24-hour NCCT follow-up for analysis of HE. The accuracy of this grading system was assessed. Independent predictors of HE were identified using multivariable regression. Of 266 patients with ICH, 61 (22.93%) presented with the island sign, 63 (23.68%) presented with the blend sign, and 50 (18.80%) presented with the swirl sign. The overall incidence of HE was 37.22% (99/266). Of 125 patients (46.99%) who underwent a baseline CT scan within 6 hours of onset, 141 (53.01%) underwent a scan in 6-24 hours. Multivariable logistic regression analysis identified the hematoma volume (OR, 0.974; P = 0.042), intraventricular hemorrhage (IVH) extension (OR, 3.225; P = 0.003), time from onset to the baseline CT scan (OR, 0.986; P < 0.001), and anticoagulant use or an international normalized ratio (INR) > 1.5 (OR, 3.362; P = 0.006) as closely associated with HE. In conclusion, the grading system demonstrated reliable accuracy at predicting HE. The grading system demonstrated acceptable accuracy in an independent single-institution study. The role of the grading system in predicting HE and poor outcome in patients with ICH is significant. NCCT imaging markers may serve as key markers for HE prediction.