Department of Neurology, Northwestern University, Chicago, IL.
Center for Healthcare Studies, Institute for Public Health and Medicine (IPHAM), Northwestern University, Chicago, IL.
Crit Care Med. 2018 Sep;46(9):1480-1485. doi: 10.1097/CCM.0000000000003272.
Prophylactic levetiracetam is currently used in ~40% of patients with intracerebral hemorrhage, and the potential impact of levetircetam on health-related quality of life is unknown. We tested the hypothesis that prophylactic levetiracetam is independently associated with differences in cognitive function health-related quality of life.
Patients with intracerebral hemorrhage were enrolled in a prospective cohort study. We performed mixed models for T-scores of health-related quality of life, referenced to the U.S. population at 50 ± 10, accounting for severity of injury and time to follow-up.
Academic medical center.
One-hundred forty-two survivors of intracerebral hemorrhage.
None.
T-scores of Neuro-Quality of Life Cognitive Function v2.0 was the primary outcome, whereas Neuro-Quality of Life Mobility v1.0 and modified Rankin Scale (a global functional scale) were secondary measures. We prospectively documented if prophylactic levetiracetam was administered and retrieved administration data from the electronic health record. Patients who received prophylactic levetiracetam had worse cognitive function health-related quality of life (T-score 5.1 points lower; p = 0.01) after adjustment for age (p = 0.3), National Institutes of Health Stroke Scale (p < 0.000001), lobar hematoma (p = 0.9), and time of assessment; statistical models controlling for prophylactic levetiracetam and the Intracerebral Hemorrhage Score, a global measure of intracerebral hemorrhage severity, yielded similar results. Lower T-scores of cognitive function health-related quality of life at 3 months were correlated with more total levetiracetam dosage (p = 0.01) and more administered doses of levetiracetam in the hospital (p = 0.03). Patients who received prophylactic levetiracetam were more likely to have a lobar hematoma (27/38 vs 19/104; p < 0.001), undergo electroencephalography monitoring (15/38 vs 21/104; p = 0.02), but not more likely to have clinical seizures (4/38 vs 7/104; p = 0.5). Levetiracetam was not independently associated with the modified Rankin Scale scores or mobility health-related quality of life (p > 0.1).
Prophylactic levetiracetam was independently associated with lower cognitive function health-related quality of life at follow-up after intracerebral hemorrhage.
目前约有 40%的脑出血患者预防性使用左乙拉西坦，但其对健康相关生活质量的潜在影响尚不清楚。我们检验了这样一个假设，即预防性使用左乙拉西坦与认知功能健康相关生活质量的差异独立相关。
脑出血患者纳入前瞻性队列研究。我们使用混合模型对健康相关生活质量的 T 评分进行了分析，参考了美国 50±10 岁人群的 T 评分，同时考虑了损伤严重程度和随访时间。
学术医疗中心。
142 例脑出血幸存者。
无。
Neuro-Quality of Life Cognitive Function v2.0 的 T 评分是主要结局，而 Neuro-Quality of Life Mobility v1.0 和改良 Rankin 量表（一种全球功能量表）是次要指标。我们前瞻性地记录了是否使用预防性左乙拉西坦，并从电子病历中检索了用药数据。与未使用预防性左乙拉西坦的患者相比，使用预防性左乙拉西坦的患者认知功能健康相关生活质量较差（T 评分低 5.1 分；p=0.01），调整年龄因素后（p=0.3）、美国国立卫生研究院卒中量表（p<0.000001）、脑叶血肿（p=0.9）和评估时间因素后结果仍相似；在控制预防性左乙拉西坦和脑出血评分（一种脑出血严重程度的综合指标）的统计模型中也得到了类似的结果。3 个月时认知功能健康相关生活质量的 T 评分较低与左乙拉西坦总剂量（p=0.01）和院内左乙拉西坦给药剂量（p=0.03）相关。接受预防性左乙拉西坦治疗的患者更可能出现脑叶血肿（27/38 与 19/104；p<0.001）、更可能接受脑电图监测（15/38 与 21/104；p=0.02），但出现临床癫痫发作的可能性并无差异（4/38 与 7/104；p=0.5）。左乙拉西坦与改良 Rankin 量表评分或移动健康相关生活质量无关（p>0.1）。
脑出血后，预防性使用左乙拉西坦与随访时认知功能健康相关生活质量较低独立相关。
