From the Neurological Department (B.V., A.G.-J., S.T.G., J.A.S., J.B.K., D.S., H.B.H.) and Neuroradiological Department (S.L., H.L.), University of Erlangen-Nuremberg, Germany; Department of Neurology (D.S.), Hospital of the Brothers of St. John, Eisenstadt, Austria; and Department of Neurology (B.V.), Inselspital, University Hospital of Bern, Switzerland.
Neurology. 2018 Mar 20;90(12):e1005-e1012. doi: 10.1212/WNL.0000000000005167. Epub 2018 Feb 16.
To evaluate the association of perihemorrhagic edema (PHE) evolution and peak edema extent with day 90 functional outcome in patients with intracerebral hemorrhage (ICH) and identify pathophysiologic factors influencing edema evolution.
This retrospective cohort study included patients with spontaneous supratentorial ICH between January 2006 and January 2014. ICH and PHE volumes were studied using a validated semiautomatic volumetric algorithm. Multivariable logistic regression and propensity score matching (PSM) accounting for age, ICH volume, and location were used for assessing measures associated with functional outcome and PHE evolution. Clinical outcome on day 90 was assessed using the modified Rankin Scale (0-3 = favorable, 4-6 = poor).
A total of 292 patients were included. Median age was 70 years (interquartile range [IQR] 62-78), median ICH volume on admission 17.7 mL (IQR 7.9-40.2). Besides established factors for functional outcome, i.e., ICH volume and location, age, intraventricular hemorrhage, and NIH Stroke Scale score on admission, multivariable logistic regression revealed peak PHE volume (odds ratio [OR] 0.984 [95% confidence interval (CI) 0.973-0.994]) as an independent predictor of day 90 outcome. Peak PHE volume was independently associated with initial PHE increase up to day 3 (OR 1.060 [95% CI 1.018-1.103]) and neutrophil to lymphocyte ratio on day 6 (OR 1.236 [95% CI 1.034-1.477; PSM cohort, n = 124]). Initial PHE increase (PSM cohort, n = 224) was independently related to hematoma expansion (OR 3.647 [95% CI 1.533-8.679]) and fever burden on days 2-3 (OR 1.456 [95% CI 1.103-1.920]).
Our findings suggest that peak PHE volume represents an independent predictor of functional outcome after ICH. Inflammatory processes and hematoma expansion seem to be involved in PHE evolution and may represent important treatment targets.
评估脑出血（ICH）患者的脑内血肿周围水肿（PHE）演变和水肿峰值程度与 90 天功能结局的相关性，并确定影响水肿演变的病理生理因素。
本回顾性队列研究纳入了 2006 年 1 月至 2014 年 1 月期间发生自发性幕上 ICH 的患者。使用一种经过验证的半自动容积算法研究 ICH 和 PHE 体积。多变量逻辑回归和倾向评分匹配（PSM）用于评估与功能结局和 PHE 演变相关的指标，考虑了年龄、ICH 体积和部位等因素。90 天时的临床结局采用改良 Rankin 量表（0-3=良好，4-6=不良）进行评估。
共纳入 292 例患者。中位年龄为 70 岁（四分位间距 [IQR] 62-78），入院时 ICH 体积中位数为 17.7 mL（IQR 7.9-40.2）。除了功能结局的既定因素，即 ICH 体积和部位、年龄、脑室出血和入院时 NIH 卒中量表评分外，多变量逻辑回归显示，峰值 PHE 体积（比值比 [OR] 0.984[95%置信区间（CI）0.973-0.994]）是 90 天结局的独立预测因素。峰值 PHE 体积与第 3 天的初始 PHE 增加（OR 1.060[95%CI 1.018-1.103]）和第 6 天的中性粒细胞与淋巴细胞比值（OR 1.236[95%CI 1.034-1.477；PSM 队列，n=124]）独立相关。初始 PHE 增加（PSM 队列，n=224）与血肿扩大（OR 3.647[95%CI 1.533-8.679]）和第 2-3 天发热负担（OR 1.456[95%CI 1.103-1.920]）独立相关。
我们的研究结果表明，峰值 PHE 体积是 ICH 后功能结局的独立预测因素。炎症过程和血肿扩大似乎参与了 PHE 的演变，可能是重要的治疗靶点。
