Forlivesi Stefano, Turcato Gianni, Zivelonghi Cecilia, Zannoni Massimo, Ricci Giorgio, Cervellin Gianfranco, Lippi Giuseppe, Bovi Paolo, Bonetti Bruno, Cappellari Manuel
Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
Emergency Department, Girolamo Fracastoro Hospital, Verona, Italy.
J Stroke Cerebrovasc Dis. 2018 Sep;27(9):2519-2523. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.007. Epub 2018 May 24.
We investigated the association of short- and medium-term particulate matter (PM) exposure with risk of mortality in patients with spontaneous intracerebral hemorrhage (ICH) identified according to strict etiologic criteria.
We conducted a retrospective analysis of prospectively collected data from consecutive patients with spontaneous ICH admitted to the emergency department of the University Hospital of Verona from March 2011 to December 2014. Outcome measures were mortality within 1 month after ICH and significant hematoma expansion (HE) defined as an absolute growth of more than 12.5 mL or a relative increase of more than 50% from baseline to follow-up computed tomography scan.
A final number of 308 patients were included. In the adjusted model, higher PM and PM values in the last 3 days (odds ratio [OR] 1.827, 95% confidence interval [CI] 1.057-3.159, P = .031 and OR 1.949, 95% CI 1.025-3.704, P = .042, respectively) and in the last 4 weeks (OR 4.975, 95% CI 2.174-11.381, P < .001 and OR 9.781, 95% CI 3.425-27.932, P < .001, respectively) before ICH were associated with higher mortality rate. No association was found between PM exposure and significant HE.
PM exposure in the short- and medium-term before spontaneous ICH was associated with risk of 1-month mortality, independent of predictors such as age, sex, stroke severity, intraventricular hemorrhage, ICH volume, ICH location, ICH etiologic subtype, significant HE, antithrombotic therapy, atrial fibrillation, and blood glucose levels.
我们根据严格的病因学标准，研究了短期和中期颗粒物（PM）暴露与自发性脑出血（ICH）患者死亡风险之间的关联。
我们对2011年3月至2014年12月在维罗纳大学医院急诊科收治的连续性自发性ICH患者的前瞻性收集数据进行了回顾性分析。结局指标为ICH后1个月内的死亡率以及显著血肿扩大（HE），显著血肿扩大定义为从基线到随访计算机断层扫描的绝对增长超过12.5 mL或相对增加超过50%。
最终纳入308例患者。在调整模型中，ICH前最后3天较高的PM和PM值（优势比[OR]分别为1.827，95%置信区间[CI]为1.057 - 3.159，P = 0.031；OR为1.949，95% CI为1.025 - 3.704，P = 0.042）以及最后4周（OR分别为4.975，95% CI为2.174 - 11.381，P < 0.001；OR为9.781，95% CI为3.425 - 27.932，P < 0.001）与较高的死亡率相关。未发现PM暴露与显著HE之间存在关联。
自发性ICH前的短期和中期PM暴露与1个月死亡率风险相关，独立于年龄、性别、中风严重程度、脑室内出血、ICH体积、ICH位置、ICH病因亚型、显著HE、抗血栓治疗、心房颤动和血糖水平等预测因素。
