Department of Neurology, Seoul National University Hospital, Seoul, 110-744, Republic of Korea.
Neurology. 2010 May 11;74(19):1502-10. doi: 10.1212/WNL.0b013e3181dd425a.
The ability to predict poor outcome is important for patient care and treatment decision-making in cases of intracerebral hemorrhage (ICH). Previous studies have included relatively brief follow-up periods and small numbers of patients, and are limited in terms of considerations regarding individual brain vulnerabilities.
The authors prospectively enrolled 1,321 ICH patients nationwide from 33 hospitals. Clinical, laboratory, and imaging variables, including white matter lesions (WMLs), were collected at admission. Immediate outcome after ICH was measured using total Glasgow Coma Scale (GCS) score at admission, early outcome using 30-day mortality, and long-term outcome using relative risk for mortality. The vital status of included patients was ascertained on December 31, 2006, using Korean National Death Certificates (mean follow-up, 32.6 months).
Of the 1,321 ICH patients included, 352 (27.8%) presented with a moderate GCS score (8.5-12.4) and 249 (19.7%) with a severe GCS score (</=8.4). The mortality rate was 9.1% at day 30 post-ICH and 381 patients (29.8%) had died up to the end of December 2006. Extensive WMLs were associated with severe GCS scores at admission (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.73-3.46), 30-day mortality (OR 2.52, 95% CI 1.33-4.75), and the relative risk for mortality (RR 2.61, 95% CI 1.79-3.82) after adjusting for relevant covariates.
These findings suggest that white matter lesions, which may reflect the vulnerability of individual brains to pathologic insults, should be considered when assessing immediate, early, and long-term outcomes after intracerebral hemorrhage.
对于脑出血（ICH）患者的护理和治疗决策，预测不良预后的能力非常重要。先前的研究包括相对较短的随访期和较少的患者数量，并且在考虑个体大脑脆弱性方面存在局限性。
作者在全国范围内从 33 家医院前瞻性纳入了 1321 例 ICH 患者。入院时收集了临床、实验室和影像学变量，包括脑白质病变（WML）。ICH 后即刻结果采用入院时总格拉斯哥昏迷量表（GCS）评分测量，早期结果采用 30 天死亡率测量，长期结果采用死亡率的相对风险测量。通过韩国国家死亡证明确定纳入患者的生存状态，截止日期为 2006 年 12 月 31 日（平均随访 32.6 个月）。
在纳入的 1321 例 ICH 患者中，352 例（27.8%）入院时表现为中度 GCS 评分（8.5-12.4），249 例（19.7%）表现为重度 GCS 评分（<=8.4）。ICH 后第 30 天的死亡率为 9.1%，截止到 2006 年 12 月 31 日，共有 381 例患者死亡。广泛的 WMLs 与入院时严重的 GCS 评分（比值比 [OR] 2.45，95%置信区间 [CI] 1.73-3.46）、30 天死亡率（OR 2.52，95% CI 1.33-4.75）和相对死亡率风险（RR 2.61，95% CI 1.79-3.82）相关，调整相关协变量后。
这些发现表明，脑白质病变可能反映了个体大脑对病理损伤的脆弱性，在评估 ICH 后即刻、早期和长期预后时应予以考虑。
