脑出血后迟发性癫痫预测的 CAVE 评分。
The CAVE score for predicting late seizures after intracerebral hemorrhage.
机构信息
Department of Neurology (E.H., D.S., J.P., T. Sipi, S.M., T. Sairanen, S.C., R.R., M.K., T.T., A.M.) and Department of Neurosurgery (J.S.), Helsinki University Central Hospital, Helsinki, Finland; Neurology Department, EA 1046, Université Lille Nord de France, CHU Lille, Lille, France (C.R., C.C.); and Departments of Medicine and the Florey, University of Melbourne, Melbourne, Australia (A.M.).
出版信息
Stroke. 2014 Jul;45(7):1971-6. doi: 10.1161/STROKEAHA.114.004686. Epub 2014 May 29.
BACKGROUND AND PURPOSE
Seizures are a common complication of intracerebral hemorrhage (ICH). We developed a novel tool to quantify this risk in individual patients.
METHODS
Retrospective analysis of the observational Helsinki ICH Study (n=993; median follow-up, 2.7 years) and the Lille Prognosis of InTra-Cerebral Hemorrhage (n=325; 2.2 years) cohorts of consecutive ICH patients admitted between 2004 and 2010. Helsinki ICH Study patients' province-wide electronic records were evaluated for early seizures occurring within 7 days of ICH and among 7-day survivors (n=764) for late seizures (LSs) occurring >7 days from ICH. A Cox regression model estimating risk of LSs was used to derive a prognostic score, validated in the Prognosis of InTra-Cerebral Hemorrhage cohort.
RESULTS
Of the Helsinki ICH Study patients, 109 (11.0%) had early seizures within 7 days of ICH. Among the 7-day survivors, 70 (9.2%) patients developed LSs. The cumulative risk of LSs was 7.1%, 10.0%, 10.2%, 11.0%, and 11.8% at 1 to 5 years after ICH, respectively. We created the CAVE score (0-4 points) to estimate the risk of LSs, with 1 point for each of cortical involvement, age<65 years, volume>10 mL, and early seizures within 7 days of ICH. The risk of LSs was 0.6%, 3.6%, 9.8%, 34.8%, and 46.2% for CAVE scores 0 to 4, respectively. The c-statistic was 0.81 (0.76-0.86) and 0.69 (0.59-0.78) in the validation cohort.
CONCLUSIONS
One in 10 patients will develop seizures after ICH. The risk of this adverse outcome can be estimated by a simple score based on baseline variables.
背景与目的
癫痫发作是脑出血（ICH）的常见并发症。我们开发了一种新的工具来量化个体患者的这种风险。
方法
对 2004 年至 2010 年间连续收治的观察性赫尔辛基脑出血研究（n=993；中位随访 2.7 年）和里尔脑出血预后研究（n=325；2.2 年）队列的患者进行回顾性分析。评估赫尔辛基脑出血研究患者全省范围内的电子病历，以确定ICH 后 7 天内发生的早期癫痫发作，并在 7 天幸存者（n=764）中确定ICH 后>7 天发生的晚期癫痫发作（LSs）。使用 Cox 回归模型估计 LSs 的风险，以推导预后评分，并在预后的脑出血研究队列中进行验证。
结果
在赫尔辛基脑出血研究患者中，109 例（11.0%）ICH 后 7 天内发生早期癫痫发作。在 7 天幸存者中，70 例（9.2%）患者发生 LSs。ICH 后 1 至 5 年，LSs 的累积风险分别为 7.1%、10.0%、10.2%、11.0%和 11.8%。我们创建了 CAVE 评分（0-4 分）来估计 LSs 的风险，每有一个皮质受累、年龄<65 岁、体积>10 mL 和 ICH 后 7 天内的早期癫痫发作各计 1 分。CAVE 评分 0 至 4 分的 LSs 风险分别为 0.6%、3.6%、9.8%、34.8%和 46.2%。验证队列中的 C 统计量分别为 0.81（0.76-0.86）和 0.69（0.59-0.78）。
结论
每 10 名患者中就有 1 名会在脑出血后发生癫痫发作。这种不良后果的风险可以通过基于基线变量的简单评分来估计。
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