Francis Brandon A, Beaumont Jennifer, Maas Matthew B, Liotta Eric M, Cella David, Prabhakaran Shyam, Holl Jane, Kho Abel, Naidech Andrew M
Hauenstein Neurosciences, Mercy Health Saint Mary's, 220 Cherry St, Grand Rapids, MI, 49503, USA.
Institute for Public Health and Medicine, Hauenstein Neurosciences, Northwestern University, 233 Erie St, Chicago, Il 60611, USA.
J Patient Rep Outcomes. 2018 Nov 23;2(1):55. doi: 10.1186/s41687-018-0083-0.
Depressive symptoms in patients with intracerebral hemorrhage (ICH) are common and are associated with worse outcomes. It is not well described how often depressive symptoms are ascertained and treated in large unselected cohorts of patients, and whether depressive symptoms would be a potential target for improving outcomes.
Data were electronically retrieved from a multi-center EHR repository in Chicago, IL, from 2006 to 2012 ("multicenter cohort"). In the multicenter cohort, we retrieved diagnostic codes and medication data from four university health systems across Chicago. In the single center cohort, we prospectively screened for depressive symptoms (NIH Patient Reported Outcomes Measurement Information System, PROMIS, T Score ≥ 60), at one, three and twelve months after ICH onset. It should be noted that not all depressive symptoms are optimally characterized through diagnostic codes.
Diagnostic codes for depressive symptoms up to three months after ICH onset were recorded in 132 of 3422 (3.8%) of the multicenter cohort; fewer than 10% of patients received a typical medication to treat depressive symptoms, and < 2% one month later. In the single-center cohort, PROMIS assessments were indicative of depressive symptoms in 26 of 116 (22.4%), and depressive symptoms were more likely to be found with screening (OR 7.20, 95% CI 4.5-11.5, P < 0.0001). Results were similar up to 12 months after ICH.
Depressive symptoms in patients with ICH are more common than medication treatment or a coded diagnosis in a multi-center cohort, and are a potential opportunity for additional treatment to improve outcomes. There are currently no AHA/ASA treatment guidelines for depression screening of patients with ICH.
脑出血（ICH）患者的抑郁症状很常见，且与更差的预后相关。在未经过挑选的大量患者队列中，抑郁症状的确诊和治疗频率以及抑郁症状是否会成为改善预后的潜在靶点，目前尚无详尽描述。
数据从伊利诺伊州芝加哥市的一个多中心电子健康记录库中以电子方式检索，时间跨度为2006年至2012年（“多中心队列”）。在多中心队列中，我们从芝加哥的四个大学卫生系统中检索诊断代码和用药数据。在单中心队列中，我们在脑出血发作后的1个月、3个月和12个月，前瞻性地筛查抑郁症状（美国国立卫生研究院患者报告结局测量信息系统，PROMIS，T评分≥60）。需要注意的是，并非所有抑郁症状都能通过诊断代码得到最佳表征。
在多中心队列的3422例患者中，有132例（3.8%）记录了脑出血发作后3个月内的抑郁症状诊断代码；不到10%的患者接受了治疗抑郁症状的典型药物，1个月后这一比例<2%。在单中心队列中，116例患者中有26例（22.4%）PROMIS评估表明存在抑郁症状，通过筛查更有可能发现抑郁症状（比值比7.20，95%置信区间4.5 - 11.5，P < 0.0001）。脑出血后长达12个月的结果相似。
脑出血患者的抑郁症状比多中心队列中的药物治疗或编码诊断更为常见，是进行额外治疗以改善预后的潜在机会。目前尚无美国心脏协会/美国卒中协会关于脑出血患者抑郁筛查的治疗指南。
