Murthy Santosh B, Urday Sebastian, Beslow Lauren A, Dawson Jesse, Lees Kennedy, Kimberly W Taylor, Iadecola Costantino, Kamel Hooman, Hanley Daniel F, Sheth Kevin N, Ziai Wendy C
Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, New York, USA Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.
Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
J Neurol Neurosurg Psychiatry. 2016 Nov;87(11):1169-1173. doi: 10.1136/jnnp-2016-313653. Epub 2016 Jul 27.
Perihaematomal edema (PHE) expansion rate may be a predictor of outcome after intracerebral haemorrhage (ICH). We determined whether PHE expansion rate in the first 72 hours after ICH predicts outcome, and how it compares against other PHE measures.
We included patients from the Virtual International Stroke Trials Archive. We calculated PHE expansion rate using the equation: (PHE at 72 hours PHE at baseline)/(time to 72-hour CT scan time to baseline CT scan). Outcomes of interest were mortality and poor 90-day outcome (modified Rankin Scale score of ≥3). Logistic regression was used to assess relationships with outcome.
A total of 596 patients with ICH were included. At baseline, median haematoma volume was 15.0 mL (IQR 7.9-29.2) with median PHE volume of 8.7 mL (IQR 4.5-15.5). Median PHE expansion rate was 0.31 mL/hour (IQR 0.12-0.55). The odds of mortality were greater with increasing PHE expansion rate (OR 2.63, CI 1.10 to 6.25), while the odds of poor outcome also increased with greater PHE growth (OR 1.67, CI 1.28 to 2.39). Female sex had an inverse relationship with PHE growth, but baseline haematoma volume had a direct correlation. Among other PHE measures, only interval increase in PHE correlated with poor outcome. There was no significant difference between the 2 measures of PHE volume expansion.
Rate of PHE growth over 72 hours was an independent predictor of mortality and poor functional outcomes following ICH. Baseline haematoma volume and gender appear to influence PHE growth.
血肿周围水肿（PHE）扩展率可能是脑出血（ICH）后预后的一个预测指标。我们确定了脑出血后72小时内的PHE扩展率是否能预测预后，以及它与其他PHE测量指标相比如何。
我们纳入了虚拟国际卒中试验档案中的患者。我们使用以下公式计算PHE扩展率：（72小时时的PHE - 基线时的PHE）/（到72小时CT扫描的时间 - 到基线CT扫描的时间）。感兴趣的结局是死亡率和90天不良结局（改良Rankin量表评分≥3）。使用逻辑回归评估与结局的关系。
共纳入596例ICH患者。基线时，血肿体积中位数为15.0 mL（四分位间距7.9 - 29.2），PHE体积中位数为8.7 mL（四分位间距4.5 - 15.5）。PHE扩展率中位数为0.31 mL/小时（四分位间距0.12 - 0.55）。随着PHE扩展率增加，死亡几率更高（比值比2.63，可信区间1.10至6.25），而随着PHE增长，不良结局几率也增加（比值比1.67，可信区间1.28至2.39）。女性性别与PHE增长呈负相关，但基线血肿体积与之呈正相关。在其他PHE测量指标中，只有PHE的区间增加与不良结局相关。PHE体积扩展的两种测量方法之间无显著差异。
72小时内PHE的增长速度是脑出血后死亡率和不良功能结局的独立预测指标。基线血肿体积和性别似乎会影响PHE的增长。
