From the Departments of Neurology (R.-J.K., E.H., D.S., A.M., S.M., T.T., J.P.), Neurosurgery (J.S., M.N.), and Medical Imaging Center (H.S., O.S.), Helsinki University Central Hospital, Helsinki, Finland; and Departments of Medicine and Florey, University of Melbourne, Melbourne, Victoria, Australia (A.M.).
Stroke. 2014 Aug;45(8):2454-6. doi: 10.1161/STROKEAHA.114.006020. Epub 2014 Jun 19.
Patient and radiological characteristics of intracerebral hemorrhage (ICH), surgical treatment, and outcome after ICH are interrelated. Our purpose was to define whether these characteristics or surgical treatment correlate with mortality among young adults.
We retrospectively reviewed clinical and imaging data of all first-ever nontraumatic patients with ICH between 16 and 49 years of age treated in our hospital between January 2000 and March 2010 and linked these data with national causes of death registry. A logistic regression analysis of factors associated with 3-month mortality and a propensity score comparison between patients treated conservatively and operatively was performed.
Among the 325 eligible patients (59.4% men), factors associated with 3-month mortality included higher National Institutes of Health Stroke Scale score, infratentorial location, hydrocephalus, herniation, and multiple hemorrhages. Adjusted for these factors, as well as demographics, ICH volume, and the underlying cause, surgical evacuation was associated with lower 3-month mortality (odds ratio, 0.06; 95% confidence interval, 0.02-0.21). In propensity score-matched analysis, 3-month case fatality rates were 3-fold in those treated conservatively (27.5% versus 7.8%; P<0.001).
The predictors of short-term case fatality are alike in young and elderly patients with ICH. However, initial hematoma evacuation was associated with lower 3-month case fatality in our young patients with ICH.
脑出血（ICH）患者和影像学特征、ICH 的外科治疗及治疗结果相互关联。本研究旨在确定这些特征或外科治疗是否与青年ICH 患者的死亡率相关。
回顾性分析 2000 年 1 月至 2010 年 3 月期间我院收治的所有 16~49 岁的首次非外伤性 ICH 患者的临床和影像学资料，并与国家死因登记处的数据相关联。采用 logistic 回归分析与 3 个月死亡率相关的因素，并对接受保守治疗和手术治疗的患者进行倾向评分比较。
在 325 例符合条件的患者（59.4%为男性）中，与 3 个月死亡率相关的因素包括更高的 NIHSS 评分、幕下部位、脑积水、脑疝和多发血肿。校正这些因素以及人口统计学、ICH 体积和基础病因后，血肿清除术与较低的 3 个月死亡率相关（比值比，0.06；95%置信区间，0.02~0.21）。在倾向评分匹配分析中，保守治疗的 3 个月病死率是手术治疗的 3 倍（27.5%比 7.8%；P<0.001）。
ICH 年轻和老年患者短期病死率的预测因素相似。然而，在我们的年轻ICH 患者中，初始血肿清除与较低的 3 个月病死率相关。
