Department of Neurology, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY, 10032, USA.
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Neurocrit Care. 2018 Aug;29(1):77-83. doi: 10.1007/s12028-018-0514-z.
BACKGROUND/PURPOSE: Primary intracerebral hemorrhage (ICH) studies often use hematoma location rather than ICH etiologies when assessing outcome. Characterizing ICH using hematoma location is effective/reproducible, but may miss heterogeneity among these ICH locations, particularly lobar ICH where competing primary ICH etiologies are possible. We subsequently investigated baseline characteristics/outcome differences of spontaneous, primary ICH by their etiologies: cerebral amyloid angiopathy (CAA) and hypertension.
Primary ICH clinical/outcomes data were prospectively collected between 2009 and 2015. Modified Boston criteria were used to identify "probable/definite" and "possible" CAA-ICH, which were evaluated separately. SMASH-U criteria were used to identify hypertension ICH. Medication and systemic disease coagulopathy ICH were excluded. Baseline characteristics/outcomes among "probable/definite" CAA-ICH, "possible" CAA-ICH, and hypertension ICH were compared using logistic regression. Mortality models using ICH etiologies compared to hematoma location as predictor variables were assessed.
Two hundred and four hypertension ICHs, 55 "probable/definite" CAA-ICHs, and 46 "possible" CAA-ICHs were identified. Despite older age and larger ICH volumes, lower hospital mortality was seen in "probable/definite" CAA-ICH versus hypertension ICH (OR 0.2; 95% CI 0.05-0.8; p = 0.02) after adjusting for female gender, components of ICH score, and EVD placement. There were no mortality differences between "possible" CAA-ICH and hypertension ICH. However, lower hospital mortality was seen in "probable/definite" versus "possible" CAA-ICH (OR 0.2; 95% CI 0.04-0.7; p = 0.02). When using ICH etiology rather than hematoma location, hospital mortality models significantly improved (χ: [df = 2, N = 305] = 6.2; p = 0.01).
Further investigation is required to confirm the mortality heterogeneity seen within our primary ICH cohort. Hematoma location may play a role for these findings, but the mortality differences seen among lobar ICH using CAA-ICH subtypes and a failure to identify mortality differences between "possible" CAA-ICH and hypertension ICH suggest the limitations of accounting for hematoma location alone.
背景/目的：原发性脑出血（ICH）研究在评估结果时，通常使用血肿部位而不是 ICH 病因。使用血肿部位来描述 ICH 是有效的/可重复的，但可能会忽略这些 ICH 部位之间的异质性，尤其是在可能存在竞争原发性 ICH 病因的脑叶 ICH 中。随后，我们根据病因对自发性、原发性 ICH 的基线特征/结局差异进行了研究：脑淀粉样血管病（CAA）和高血压。
原发性 ICH 的临床/结局数据是在 2009 年至 2015 年期间前瞻性收集的。采用改良波士顿标准来识别“可能/确定”和“可能”的 CAA-ICH，并分别进行评估。SMASH-U 标准用于识别高血压性 ICH。排除了药物和系统性疾病凝血障碍性 ICH。使用逻辑回归比较“可能/确定”CAA-ICH、“可能”CAA-ICH 和高血压性 ICH 之间的基线特征/结局。评估了使用 ICH 病因与血肿部位作为预测变量的死亡率模型。
确定了 204 例高血压性 ICH、55 例“可能/确定”CAA-ICH 和 46 例“可能”CAA-ICH。尽管年龄较大，血肿体积较大，但与高血压性 ICH 相比，“可能/确定”CAA-ICH 的住院死亡率较低（OR 0.2；95%CI 0.05-0.8；p=0.02），调整女性性别、ICH 评分组成部分和 EVD 放置后。“可能”CAA-ICH 和高血压性 ICH 之间的死亡率没有差异。然而，“可能/确定”CAA-ICH 的住院死亡率低于“可能”CAA-ICH（OR 0.2；95%CI 0.04-0.7；p=0.02）。当使用 ICH 病因而不是血肿部位时，住院死亡率模型显著改善（χ：[df=2，N=305]=6.2；p=0.01）。
需要进一步调查以确认我们原发性 ICH 队列中观察到的死亡率异质性。血肿部位可能对这些发现起作用，但在使用 CAA-ICH 亚型的脑叶 ICH 中观察到的死亡率差异以及未能确定“可能”CAA-ICH 和高血压性 ICH 之间的死亡率差异表明，仅考虑血肿部位存在局限性。
