Time course and predictors of neurological deterioration after intracerebral hemorrhage.
Time course and predictors of neurological deterioration after intracerebral hemorrhage.
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DOI：
10.1161/strokeaha.114.007704
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发表时间：
2015-03
期刊：
影响因子：
8.3
通讯作者：
VISTA-ICH Collaboration
中科院分区：
文献类型：
--
作者：
Lord AS;Gilmore E;Choi HA;Mayer SA;VISTA-ICH Collaboration
神经功能恶化（ND）是脑出血（ICH）后的一种毁灭性并发症，但对时间进程和预测因素知之甚少。我们对ICH试验中的安慰剂患者进行了一项回顾性队列研究。我们在出现症状的3小时内以及24小时和72小时进行CT扫描;并在基线、1小时和第1、2、3和15天进行临床评估。预先定义ND的时间：超急性（1小时内）、急性（1-24小时）、亚急性（1-3天）和延迟（3-15天）。我们招募了376名患者，其中176名（47%）在15天内患有ND。在对ND分类的多变量分析中，超急性ND与血肿扩大相关（OR 3.6，95% CI 1.7-7.6）和基线ICH体积（OR 1.04/mL，95%CI 1.02-1.06）;急性ND伴血肿扩大（OR 7.59，95% CI 3.91-14.74），基线ICH体积（OR 1.02/mL，95% CI 1.01-1.04），入院GCS（OR 0.77/点，95% CI 0.65-0.91）和室间出血（IVH）（OR 2.14，95% CI 1.05-4.35）;亚急性ND伴72小时水肿（OR 1.03/mL，95% CI 1.02-1.05）和发热（OR 2.49，95%CI 1.01-6.14）;随着年龄的增长，（OR 1.11/年，95% CI 1.04-1.18）、肌钙蛋白（OR 4.30/点，95% CI 1.71-10.77）和感染（OR 3.69，95% CI 1.11-12.23）。ND患者的90天改良兰金评分更差（5比3，p<0.001）。神经功能恶化经常发生，并预测不良结局。我们的研究结果提示早期ND有血肿扩大和IVH，晚期ND有脑水肿、发热和内科并发症。
Neurological deterioration (ND) is a devastating complication following intracerebral hemorrhage (ICH) but little is known about time course and predictors. We performed a retrospective cohort study of placebo patients in ICH trials. We performed CT scans within 3 hours of symptoms and at 24- and 72-hours; and clinical evaluations at baseline, 1-hour, and days 1, 2, 3, and 15. Timing of ND was predefined: hyperacute (within 1 hour), acute (1-24 hours), subacute (1-3 days), and delayed (3-15 days). We enrolled 376 patients and 176 (47%) had ND within 15 days. In multivariate analyses of ND by category, hyperacute ND was associated with hematoma expansion (OR 3.6, 95% CI 1.7-7.6) and baseline ICH volume (OR 1.04 per mL, 95% CI 1.02-1.06) ; acute ND with hematoma expansion (OR 7.59, 95% CI 3.91-14.74), baseline ICH volume (OR 1.02 per mL, 95% CI 1.01-1.04), admission GCS (OR 0.77 per point, 95% CI 0.65-0.91) and interventricular hemorrhage (IVH) (OR 2.14, 95% CI 1.05-4.35); subacute ND with 72-hour edema (OR 1.03 per mL, 95% CI 1.02-1.05) and fever (OR 2.49, 95% CI 1.01-6.14); and delayed ND with age (OR 1.11 per year, 95% CI 1.04-1.18), troponin (OR 4.30 per point, 95% CI 1.71-10.77) and infections (OR 3.69, 95% CI 1.11-12.23). Patients with ND had worse 90-day modified Rankin scores (5 vs. 3, p<0.001). Neurological deterioration occurs frequently and predicts poor outcomes. Our results implicate hematoma expansion and IVH in early ND, and cerebral edema, fever, and medical complications in later ND.