Hemostasis, Hematoma Expansion, and Outcomes After Intracerebral Hemorrhage

脑出血后的止血、血肿扩张和结果

• 批准号: 10598712
• 负责人: ANDREW M NAIDECH
• 金额: $ 30.01万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10598712
• 关键词: Accountability; Acute; Acute Disease; Address; Affect; Aging; Algorithms; American; Americas; Anticoagulants; Artificial Intelligence; Award; Biological Markers; Blood coagulation; Brain; Caregivers; Caring; Catchment Area; Cerebral hemisphere hemorrhage; Cessation of life; Clinical; Clinical Data; Consumption; Data; Data Set; Data Sources; Decision Making; Development; Diagnosis; Diagnostic; Disease; Disease model; Electronic Health Record; Ethical Issues; Ethics; Ethnic Origin; Event; Exposure to; Family member; Fever; Fright; Future; Gastrostomy; Geography; Growth; Hand; Health; Hematoma; Hemorrhage; Hemostatic Agents; Hemostatic function; Hour; Hypertension; Informatics; Ingestion; Interview; Lead; Life; Location; Machine Learning; Measures; Medical; Methods; Minority; Modeling; Myocardial Infarction; Neurology; Nurses; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Pharmacists; Physicians; Population Heterogeneity; Prevalence; Process; Qualitative Research; ROC Curve; Race; Recommendation; Research; Resources; Rural; Savings; Scanning; Seizures; Severities; Status Epilepticus; Stroke; Structure; Symptoms; Testing; Therapeutic; Thrombosis; Time; Training; Travel; Treatment outcome; Trust; United States National Institutes of Health; Vascular Diseases; Vulnerable Populations; Work; X-Ray Computed Tomography; adverse event risk; artificial intelligence algorithm; base; brain tissue; clinical practice; clopidogrel; cranium; disability; diverse data; follow-up; health care availability; health care service; health related quality of life; high risk; model development; neuroimaging; patient population; prediction algorithm; prevent; prothrombin complex concentrates; racial difference; risk minimization; rural area; sex; side effect; suburb

PROJECT SUMMARY Intracerebral hemorrhage (ICH), bleeding into brain tissue, is often disabling or deadly. Complications of ICH compound the impact on patient outcome. Hematoma expansion is growth of the hematoma from the first (diagnostic) computed tomography (CT) scan to a follow-up CT scan, and occurs in 10-25% of patients. Reducing hematoma expansion reduces death and disability by keeping small hematomas small. Otherwise, hematoma expansion will compress brain tissue in the limited space in the skull. Hemostatic medication (e.g., prothrombin complex concentrate) is effective in reducing hematoma expansion in patients at high risk for hematoma expansion. However, our ability to predict hematoma expansion and select patients for hemostatic medication is limited. Unfortunately, hemostatic medication has potential side effects, such as myocardial infarction. Separately, seizures occur in about 10% of patients and may progress to status epilepticus (continual seizures). Unfortunately, a practice of widespread seizure medications also leads to complications, worse patient outcomes, and reduced health-related quality of life at follow-up. Patient care is harmed because we cannot select patients for potentially life-saving treatments (hemostatic treatment, seizure medications). ML/AI provide a solution to these roadblocks. We have developed ML/AI algorithms to solve these roadblocks of targeting hemostatic treatment and seizure medications in the context of an ongoing award to predict hematoma expansion using ML of multiple measures of blood clotting (biomarkers of hemostasis). However, significant ethical issues remain unresolved. ML/AI algorithms may be subject to unforeseen bias in the patient populations from which they are developed. Bias may lead to different performance in patients considered vulnerable by the NIH (e.g., minority race, rural location, access to healthcare services). Previous qualitative interviews with clinicians (nurses, pharmacists, physicians) have revealed deep ambivalence about the use of ML/AI. There is excitement about consistent treatment recommendations and availability at all hours, but also concerns about bias, accountability, and oversight. Such qualitative research has not been performed in the setting of ICH, which requires emergent decision making because hematoma expansion and seizures occur within hours of ICH symptom onset. In the context of our ongoing award, we will determine if preliminary ML/AI algorithms we have developed have different performance in vulnerable patients; if needed, we will develop methods to correct it, assisted by diverse data sources in hand and established predictors of hematoma expansion and seizures. We will perform qualitative interviews with clinicians, patients, and family members affected by ICH to identify and address concerns that must be addressed if ML/AI is to be trusted in ICH. This proposal will serve as a model for other acute diseases that require emergent decision making.

项目摘要 脑出血（ICH），出血进入脑组织，通常是致残或致命的。ICH并发症 加重了对患者结局的影响。血肿扩张是指血肿从最初的 （诊断性）计算机断层扫描（CT）扫描到后续CT扫描，发生在10 - 25%的患者中。 减少血肿扩大可减少死亡和残疾，使小血肿保持较小。否则， 血肿扩张会将脑组织压缩在颅骨的有限空间中。止血药物（例如， 凝血酶原复合物浓缩物）可有效减少高风险患者的血肿扩张， 血肿扩大。然而，我们预测血肿扩大和选择止血患者的能力 药物有限。不幸的是，止血药物有潜在的副作用，如心肌梗死。 梗塞另外，约10%的患者发生癫痫发作，并可能进展为癫痫持续状态 （连续发作）。不幸的是，广泛使用癫痫药物的做法也会导致并发症， 患者结局更差，随访时健康相关生活质量降低。患者护理受到伤害，因为 我们不能选择患者进行可能挽救生命的治疗（止血治疗、癫痫药物治疗）。 ML/AI为这些障碍提供了解决方案。 我们开发了ML/AI算法来解决这些针对止血治疗和癫痫发作的障碍 正在进行的使用多种指标的ML预测血肿扩大的奖励背景下的药物 凝血（止血生物标志物）。然而，重大的道德问题仍未解决。ml/AI 算法可能会受到开发它们的患者群体中不可预见的偏差的影响。偏置 可能导致NIH认为脆弱的患者的不同表现（例如，农村少数民族 位置，获得医疗保健服务）。先前与临床医生（护士，药剂师， 医生）对ML/AI的使用表现出深刻的矛盾心理。有一种兴奋， 治疗建议和随时可用性，但也关注偏见，问责制， 上级要员此类定性研究尚未在非物质文化遗产背景下进行，这需要紧急 因为血肿扩大和癫痫发作发生在ICH症状发作的数小时内。 在我们正在进行的奖项的背景下，我们将确定我们开发的初步ML/AI算法是否具有 不同的表现在脆弱的病人;如果需要，我们将制定方法来纠正它，协助 掌握了多种数据来源，并建立了血肿扩大和癫痫发作的预测因子。我们将执行 对受ICH影响的临床医生、患者和家庭成员进行定性访谈，以识别和解决 如果要在ICH中信任ML/AI，必须解决这些问题。这一建议将成为其他国家的典范。 需要紧急决策的急性疾病。

项目成果

P2Y12 inhibitor use predicts hematoma expansion in patients with intracerebral hemorrhage.

P2Y12 抑制剂的使用可预测脑出血患者的血肿扩大。

• DOI: 10.1002/acn3.52070
• 发表时间: 2024
• 期刊: Annals of clinical and translational neurology
• 影响因子: 5.3
• 作者: Houskamp,EthanJ;Liu,Yuzhe;SilvaPinheirodoNascimento,Juliana;Jahromi,BabakS;Lindholm,PaulF;Kwaan,HauC;Naidech,AndrewM
• 通讯作者: Naidech,AndrewM

From One-Size-Fits-All to Mechanism-Guided Treatment for Intracranial Hemorrhage.

从一刀切到机制引导的颅内出血治疗。

• DOI: 10.1097/ccm.0000000000004055
• 发表时间: 2019
• 期刊: Critical care medicine
• 影响因子: 8.8
• 作者: Naidech,AndrewM

The Story of Intracerebral Hemorrhage: From Recalcitrant to Treatable Disease.

• DOI: 10.1161/strokeaha.121.033484
• 发表时间: 2021-05
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Broderick JP;Grotta JC;Naidech AM;Steiner T;Sprigg N;Toyoda K;Dowlatshahi D;Demchuk AM;Selim M;Mocco J;Mayer S
• 通讯作者: Mayer S