Sakuta Kenichi, Sato Takeo, Komatsu Teppei, Sakai Kenichiro, Terasawa Yuka, Mitsumura Hidetaka, Iguchi Yasuyuki
Department of Neurology, The Jikei University School of Medicine, Japan.
Department of Neurology, The Jikei University School of Medicine, Japan.
J Stroke Cerebrovasc Dis. 2018 Oct;27(10):2606-2612. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.020. Epub 2018 Jun 27.
Early hematoma expansion (HE) is not rare in intracerebral hemorrhage (ICH) patients, but detecting those patients with high risk of HE is challenging. The aim of this retrospective study was to investigate the factors associated with HE in acute ICH patients, and to develop a simple predictive scale for HE.
We retrospectively reviewed consecutive patients with primary ICH, who received an initial non-contrast computed tomography (CT) scan within 24 hours from symptom onset. Patients underwent follow-up CT scans at 6 hours, 24 hours, and 7 days after admission. We compared the clinical characteristics of patients with and without HE (defined as an increase in intracerebral hemorrhage volume >33% or an absolute increase >6 mL on follow-up CT scans), and performed a logistic regression analysis to determine the predictors of HE.
A total of 118 patients (78 men; median age 63 years; interquartile range 54-73) were included in our study. HE was observed in 30 patients (25%). HE patients showed higher rates of anticoagulant use (20% vs. 2%, respectively; P=0.003), high National Institutes of Health Stroke Scale on admission (13 vs. 7, respectively; P=0.001), and high plasma glucose (141 mg/dl vs. 113 mg/dl, respectively; P=0.001) compared with patients without HE. After multivariate logistic regression analysis, we selected three factors for defining the NAG scale (1 point as baseline National Institutes of Health Stroke Scale ≥10, 1 point as anticoagulant use, and 1 point as plasma glucose ≥133 mg/dL). The frequencies of HE associated with the NAG scale scores were as follows: score 0, 4%; score 1, 25%; score 2, 60%; score 3, 100%.
Stroke severity, hyperglycemia, and anticoagulation use were factors independently associated with HE. The NAG scale consists of readily available factors and can predict HE.
早期血肿扩大（HE）在脑出血（ICH）患者中并不少见，但识别具有高HE风险的患者具有挑战性。这项回顾性研究的目的是调查急性ICH患者中与HE相关的因素，并制定一个简单的HE预测量表。
我们回顾性分析了连续的原发性ICH患者，这些患者在症状发作后24小时内接受了首次非增强计算机断层扫描（CT）。患者在入院后6小时、24小时和7天接受随访CT扫描。我们比较了有和没有HE（定义为随访CT扫描时脑出血体积增加>33%或绝对增加>6 mL）患者的临床特征，并进行逻辑回归分析以确定HE的预测因素。
我们的研究共纳入118例患者（78例男性；中位年龄63岁；四分位间距54 - 73岁）。30例患者（25%）观察到HE。与没有HE的患者相比，HE患者的抗凝药物使用率更高（分别为20%和2%；P = 0.003）、入院时美国国立卫生研究院卒中量表评分更高（分别为13分和7分；P = 0.001）以及血糖更高（分别为141 mg/dl和113 mg/dl；P = 0.001）。经过多变量逻辑回归分析，我们选择了三个因素来定义NAG量表（1分表示基线美国国立卫生研究院卒中量表≥10分，1分表示使用抗凝药物，1分表示血糖≥133 mg/dL）。与NAG量表评分相关的HE频率如下：0分，4%；1分，25%；2分，60%；3分，100%。
卒中严重程度、高血糖和抗凝药物使用是与HE独立相关的因素。NAG量表由易于获得的因素组成，能够预测HE。
