Yuan Ruozhen, Lei Chunyan, Wu Simiao, Wei Chenchen, Xiong Yao, Xu Mangmang, Liu Junfeng, Wang Deren, Lin Sen, You Chao, Liu Ming
Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
J Stroke Cerebrovasc Dis. 2017 Mar;26(3):636-643. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.012. Epub 2016 Dec 29.
The prognostic significance of intraventricular hemorrhage (IVH) in patients with vascular structural abnormality-related intracerebral hemorrhage (VSARICH) is poorly understood.
We prospectively included consecutive patients diagnosed with VSARICH. Imaging of initial brain computed tomography (CT) scans within 48 hours of symptom onset was analyzed. The presence and severity of IVH were recorded. Severity of IVH was measured using the modified Graeb (mGraeb) score. Baseline characteristics and 3-month outcomes were compared between the IVH and non-IVH groups. Multivariate logistic regression was used to examine the independent association between IVH and 3-month outcomes.
A total of 132 VSARICH patients were included for analysis, and 71 (53.8%) of them had IVH on initial CT imaging. IVH patients had a median mGraeb score of 15 (6-21), and compared to non-IVH patients, they had shorter delay to first CT scan and higher stroke severity on admission (all P ≤ .005). At 3 months, IVH patients had higher death rates (30.3% versus 7.0%; P = .001) and poor outcome rates (48.5% versus 21.1%; P = .002) than non-IVH patients. After multivariate analysis, IVH severity was associated with 3-month death (Model 1 OR 1.112, 95% CI [1.027-1.204], P = .009; Model 2 OR 1.110, 95% CI [1.027-1.200], P = .009) and poor outcome (Model 2 OR 1.053, 95% CI [1.001-1.108], P = .047), although no independent association between IVH presence and outcomes was observed.
IVH severity measured by mGraeb score independently predicts death and poor functional outcome in patients with VSARICH.
血管结构异常相关性脑出血（VSARICH）患者脑室内出血（IVH）的预后意义尚不清楚。
我们前瞻性纳入了连续诊断为VSARICH的患者。分析症状发作后48小时内的首次脑部计算机断层扫描（CT）图像。记录IVH的存在情况和严重程度。使用改良Graeb（mGraeb）评分来衡量IVH的严重程度。比较IVH组和非IVH组的基线特征和3个月的结局。采用多因素逻辑回归分析来检验IVH与3个月结局之间的独立关联。
共纳入132例VSARICH患者进行分析，其中71例（53.8%）在首次CT成像时有IVH。IVH患者的mGraeb评分中位数为15（6 - 21），与非IVH患者相比，他们首次CT扫描的延迟时间更短，入院时的卒中严重程度更高（所有P≤0.005）。在3个月时，IVH患者的死亡率（30.3%对7.0%；P = 0.001）和不良结局率（48.5%对21.1%；P = 0.002）高于非IVH患者。多因素分析后，IVH严重程度与3个月死亡（模型1：比值比[OR]1.112，95%置信区间[CI][1.027 - 1.204]，P = 0.009；模型2：OR 1.110，95%CI[1.027 - 1.200]，P = 0.009）和不良结局（模型2：OR 1.053，95%CI[1.001 - 1.108]，P = 0.047）相关，尽管未观察到IVH的存在与结局之间的独立关联。
通过mGraeb评分测量的IVH严重程度可独立预测VSARICH患者的死亡和不良功能结局。
