Wu Teddy Y, Sharma Gagan, Strbian Daniel, Putaala Jukka, Desmond Patricia M, Tatlisumak Turgut, Davis Stephen M, Meretoja Atte
From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
Stroke. 2017 Apr;48(4):873-879. doi: 10.1161/STROKEAHA.116.014416. Epub 2017 Mar 8.
Edema may worsen outcome after intracerebral hemorrhage (ICH). We assessed its natural history, factors influencing growth, and association with outcome.
We estimated edema volumes in ICH patients from the Helsinki ICH study using semiautomated planimetry. We assessed the correlation between edema extension distance (EED) and time from ICH onset, creating an edema growth trajectory model up to 3 weeks. We interpolated expected EED at 72 hours and identified clinical and imaging characteristics associated with faster edema growth. Association of EED and mortality was assessed using logistic regression adjusting for predictors of ICH outcome.
From 1013 consecutive patients, 861 were included. There was a strong inverse correlation between EED growth rate (cm/d) and time from onset (days): EED growth=0.162*days exp(-0.927), =0.82. Baseline factors associated with larger than expected EED were older age (71 versus 68; =0.002), higher National Institutes of Health Stroke Scale score (14 versus 8; <0.001), and lower Glasgow Coma scale score (13 versus 15; <0.001), larger ICH volume (19.7 versus 12.7 mL; <0.001), larger initial EED (0.42 versus 0.30; <0.001), irregularly shaped hematoma (55% versus 42%; <0.001), and higher glucose (7.6 versus 6.9 mmol/L; =0.001). Patients with faster edema growth had more midline shift (50% versus 31%; <0.001), herniation (12% versus 4%; <0.001), and higher 6-month (46% versus 26%; <0.001) mortality. In the logistic regression model, higher-than-expected EED was associated with 6-month mortality (odds ratio, 1.60; 95% confidence interval, 1.04-2.46; =0.032).
Edema growth can be readily monitored and is an independent determinant of mortality after ICH, providing an important treatment target for strategies to improve patient outcome.
脑出血（ICH）后水肿可能会使预后恶化。我们评估了其自然病程、影响水肿扩大的因素以及与预后的关联。
我们使用半自动平面测量法估算了赫尔辛基脑出血研究中ICH患者的水肿体积。我们评估了水肿扩展距离（EED）与脑出血发病时间之间的相关性，建立了长达3周的水肿生长轨迹模型。我们插值计算了72小时时的预期EED，并确定了与水肿更快生长相关的临床和影像学特征。使用对ICH预后预测因素进行校正的逻辑回归评估EED与死亡率的关联。
在1013例连续患者中，纳入了861例。EED生长速率（厘米/天）与发病时间（天）之间存在很强的负相关：EED生长=0.162×天exp（-0.927），=0.82。与大于预期的EED相关的基线因素包括年龄较大（71岁对68岁；=0.002）、美国国立卫生研究院卒中量表评分较高（14分对8分；<0.001）、格拉斯哥昏迷量表评分较低（13分对15分；<0.001）、ICH体积较大（19.7毫升对12.7毫升；<0.001）、初始EED较大（0.42对0.30；<0.001）、血肿形状不规则（55%对42%；<0.001）以及血糖较高（7.6毫摩尔/升对6.9毫摩尔/升；=0.001）。水肿生长较快的患者中线移位更多（50%对31%；<0.001）、脑疝发生率更高（12%对4%；<0.001）且6个月死亡率更高（46%对26%；<0.001）。在逻辑回归模型中，高于预期的EED与6个月死亡率相关（比值比，1.60；95%置信区间，1.04 - 2.46；=0.032）。
水肿生长易于监测，是ICH后死亡率的独立决定因素，为改善患者预后的策略提供了一个重要的治疗靶点。
