Zulfiqar Maryam, Qeadan Fares, Ikram Asad, Farooqui Mudassir, Richardson Sarah P, Calder Christopher S, Quadri Syed A, Mathur Puja, Ford Corey, O Gutierrez Santiago, Liera Enrique, Snow Harry, N Gonzalez Joel, Zafar Atif
Department of Neurology, University of New Mexico, Albuquerque, New Mexico.
Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico.
J Stroke Cerebrovasc Dis. 2019 Feb;28(2):267-275. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.050. Epub 2018 Oct 29.
To identify the vascular risk factors associated with the occurrence of intracerebral hemorrhage (ICH) in Multiple Sclerosis (MS) patients.
This is an observational, retrospective cohort study using the nationwide electronic medical records (EMR) database. Patients with the diagnosis of MS were extracted from inpatient and outpatient EMR using the international classification of diseases, ninth/tenth revisions, clinical modification codes. We excluded patients younger than 18 years, and those where gender was not specified. Patients were further stratified based on their demographics, risk factors, medications, and comorbidities. Tobacco, diabetes, hypertension, and alcohol were the predicting variables; antiplatelet medication, and anticoagulant agents were the primary exposures for the development of ICH. A validated diagnosis code algorithm defined the diagnosis of ICH. Multivariable logistic regression models were utilized to assess the risk of ICH in MS patients.
Of the total 57,099 MS patients (women: 75%, n = 41,517), 107 (.19%) sustained an ICH. Age (OR = 2.74, CI = 1.13-6.62), use of anticoagulants (OR = 2.15, 95% CI = 1.30-3.56, P = .0028), and history of tobacco exposure (OR = 2.44, CI = 1.37-4.36, P = .0025) were associated with increased risk of ICH. Use of antiplatelet and disease-modifying drugs (DMDs) showed a protective trend against ICH.
Tobacco exposure and anticoagulant use were strongly associated with increased risk of ICH in patients with MS. There might be a protective effect that antiplatelet and DMDs have in the pathophysiology of this disease. Further prospective investigations are warranted to establish these associations.
确定与多发性硬化症（MS）患者脑出血（ICH）发生相关的血管危险因素。
这是一项使用全国电子病历（EMR）数据库的观察性回顾性队列研究。使用国际疾病分类第九/十版临床修订代码，从住院和门诊电子病历中提取诊断为MS的患者。我们排除了年龄小于18岁以及性别未明确的患者。根据患者的人口统计学、危险因素、用药情况和合并症进一步分层。烟草、糖尿病、高血压和酒精为预测变量；抗血小板药物和抗凝剂是ICH发生的主要暴露因素。采用经过验证的诊断编码算法确定ICH的诊断。使用多变量逻辑回归模型评估MS患者发生ICH的风险。
在总共57,099例MS患者（女性：75%，n = 41,517）中，107例（0.19%）发生了ICH。年龄（OR = 2.74，CI = 1.13 - 6.62）、使用抗凝剂（OR = 2.15，95%CI = 1.30 - 3.56，P = 0.0028）和有烟草暴露史（OR = 2.44，CI = 1.37 - 4.36，P = 0.0025）与ICH风险增加相关。使用抗血小板药物和疾病修饰药物（DMDs）显示出对ICH的保护趋势。
烟草暴露和使用抗凝剂与MS患者ICH风险增加密切相关。抗血小板药物和DMDs在该疾病的病理生理学中可能具有保护作用。有必要进行进一步的前瞻性研究以确定这些关联。
