Rutten-Jacobs Loes Ca, Maaijwee Noortje Am, Arntz Renate M, Schoonderwaldt Hennie C, Dorresteijn Lucille D, van Dijk Ewoud J, de Leeuw Frank-Erik
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,
J Neurol. 2014 Nov;261(11):2143-9. doi: 10.1007/s00415-014-7469-6. Epub 2014 Aug 20.
Data on determinants of prognosis after intracerebral hemorrhage (ICH) in young adults are scarce. Our aim was to identify clinical determinants of prognosis after ICH in adults aged 18-50. We investigated 98 consecutive patients with an ICH, aged 18-50 years, admitted to our hospital between 1980 and 2010. Collected ICH characteristics included presenting symptoms, etiology, location, severity and Glasgow Coma Scale (GCS). Outcomes were case-fatality (death within 30 days), poor functional outcome (modified Rankin Scale >2), long-term mortality and recurrent ICH. We assessed discriminatory power of factors associated with case-fatality [area under receiver operating curve (AUC)]. Case-fatality was 20.4 % (n = 20) and well predicted by the GCS (AUC 0.83). Among 30-day survivors, a poor functional outcome at discharge was present in 51.3 %. During a mean follow-up of 11.3 years mortality was only increased in patients aged 40-50 years [standardized mortality ratio 4.8 (95 % CI 2.3-8.6)], but not in patients aged 18-40 years. Recurrent ICH occurred in 6 patients [10-year cumulative incidence 12.2 % (95 % CI 1.5-22.9 %)], all with the index ICH attributable to structural vascular malformations. Prognosis after ICH in young adults is poor, mainly due to high case-fatality, that is well predicted by the GCS. An exception is 30-day survivors <40 years, who have a similar risk of dying as the general population. Recurrence risk is especially present in patients with structural vascular malformations, whereas risk seems to be very low in other patients.
关于年轻成年人脑出血（ICH）后预后决定因素的数据很少。我们的目的是确定18 - 50岁成年人脑出血后预后的临床决定因素。我们调查了1980年至2010年间我院收治的98例年龄在18 - 50岁的连续脑出血患者。收集的脑出血特征包括出现的症状、病因、部位、严重程度和格拉斯哥昏迷量表（GCS）。结局指标为病死率（30天内死亡）、功能预后不良（改良Rankin量表>2）、长期死亡率和脑出血复发。我们评估了与病死率相关因素的辨别能力[受试者操作特征曲线下面积（AUC）]。病死率为20.4%（n = 20），GCS对其预测效果良好（AUC 0.83）。在30天幸存者中，出院时功能预后不良的占51.3%。在平均11.3年的随访期间，仅40 - 50岁患者的死亡率有所增加[标准化死亡率4.8（95%可信区间2.3 - 8.6）]，而18 - 40岁患者则没有。6例患者发生脑出血复发[10年累积发病率12.2%（95%可信区间1.5 - 22.9%）]，所有复发性脑出血均归因于结构性血管畸形。年轻成年人脑出血后的预后较差，主要是由于病死率高，GCS对此预测效果良好。40岁以下的30天幸存者是个例外，他们的死亡风险与一般人群相似。结构性血管畸形患者的复发风险尤其高，而其他患者的复发风险似乎很低。
