Naval Neeraj S, Mirski Marek A, Carhuapoma Juan R
Department of Neurology, Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Baltimore, MD, USA.
Neurol Res. 2009 May;31(4):425-9. doi: 10.1179/174313208X353686. Epub 2008 Dec 18.
Intracerebral hemorrhage (ICH) has the highest mortality rate of all strokes. Hemphill's ICH score is commonly used to predict mortality after ICH. More recently, the ICH grading scale (ICH-GS) has been shown to improve sensitivity of 30 day mortality prediction in this patient group.
To assess the impact of admission variables not included in prediction models, such as coagulopathy, hyperglycemia, seizures and previous aspirin or statin use on 30 day mortality prediction using two contemporary prediction models.
Records of consecutive ICH patients from 1999 to 2006 were reviewed. Patients with ICH secondary to trauma or underlying lesions (e.g. brain tumors, aneurysms, arteriovenous malformations) and of infratentorial location were excluded. We dichotomized patients into a 'predicted survival group' and 'predicted death group' based on a <50% or >50% probability of death, respectively. The predicted mortality using ICH score and ICH-GS prediction models was calculated and was compared with the observed mortality in all patients and then separately in patient subgroups differentiated based on the presence or absence of coagulopathy, hyperglycemia (blood glucose> 180), seizures on presentation and previous exposure to aspirin or statins. Chi-square test was used for comparison of predicted and observed outcomes.
One hundred and twenty-five patients were included in the analysis. The overall observed mortality was 23.2% (29/125), which was significantly lower than the 34.4% mortality predicted by ICH-GS (p=0.03). Hemphill's ICH score overestimated overall mortality by 7.2% (30.4-23.2%); however, this difference was not statistically significant (p=0.14). In patients using statins before ICH, observed mortality was 38% (5/13) and 42% (5/12) of the predicted mortality using ICH-GS (p=0.03) and ICH score (p=0.04), respectively; this difference was not seen in patients not previously exposed to statins. ICH-GS (but not ICH score) significantly overestimated mortality in patients with a serum glucose <180 (p=0.02); none of the other factors analysed significantly impacted the two mortality prediction models.
The significant difference between predicted and observed mortality using ICH-GS and the ICH score in the statin cohort suggests a protective effect of statins in the setting of ICH. Such observation warrants prospective validation.
脑出血（ICH）在所有卒中类型中死亡率最高。Hemphill脑出血评分常用于预测脑出血后的死亡率。最近，脑出血分级量表（ICH - GS）已被证明可提高该患者群体30天死亡率预测的敏感性。
使用两种当代预测模型，评估预测模型未纳入的入院变量，如凝血病、高血糖、癫痫发作以及既往使用阿司匹林或他汀类药物对30天死亡率预测的影响。
回顾了1999年至2006年连续脑出血患者的记录。排除因创伤或潜在病变（如脑肿瘤、动脉瘤、动静脉畸形）继发的脑出血患者以及幕下部位脑出血患者。我们根据死亡概率分别<50%或>50%，将患者分为“预测生存组”和“预测死亡组”。计算使用ICH评分和ICH - GS预测模型的预测死亡率，并与所有患者的观察死亡率进行比较，然后分别在根据是否存在凝血病、高血糖（血糖>180）、入院时癫痫发作以及既往是否使用阿司匹林或他汀类药物区分的患者亚组中进行比较。采用卡方检验比较预测结果与观察结果。
125例患者纳入分析。总体观察死亡率为23.2%（29/125），显著低于ICH - GS预测的34.4%死亡率（p = 0.03）。Hemphill脑出血评分高估总体死亡率7.2%（30.4 - 23.2%）；然而，这种差异无统计学意义（p = 0.14）。在脑出血前使用他汀类药物的患者中，观察死亡率分别为使用ICH - GS预测死亡率的38%（5/13）和使用ICH评分预测死亡率的42%（5/12）（p分别为0.03和0.04）；在既往未使用他汀类药物的患者中未观察到这种差异。ICH - GS（而非ICH评分）显著高估血糖<180患者的死亡率（p = 0.02）；分析的其他因素均未对两种死亡率预测模型产生显著影响。
在他汀类药物队列中，使用ICH - GS和ICH评分预测的死亡率与观察到的死亡率之间存在显著差异，提示他汀类药物在脑出血情况下具有保护作用。这一观察结果有待前瞻性验证。
