From the Department of Neurological Surgery (C.-J.C., T.J.B.), University of Virginia, Charlottesville.
Department of Neurosurgery, University of Louisville, KY (D.D.).
Stroke. 2019 Mar;50(3):588-594. doi: 10.1161/STROKEAHA.118.023580.
Background and Purpose- Although cigarette use may be a risk for intracerebral hemorrhage (ICH), animal models suggest that nicotine has a potential neuroprotective effect. The aim of this multicenter study is to determine the effect of smoking history on outcome in ICH patients. Methods- We analyzed prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study and included patients with smoking status data in the analysis. Patients were dichotomized into nonsmokers versus ever-smokers, and the latter group was further categorized as former (>30 days before ICH) or current (≤30 days before ICH) smokers. The primary outcome was 90-day modified Rankin Scale score shift analysis. Secondary outcomes were in-hospital mortality and mortality, Barthel Index, and self-reported health status measures at 90 days. Results- The overall study cohort comprised 1509 nonsmokers and 1423 ever-smokers (841 former, 577 current, 5 unknown). No difference in primary outcome was observed between nonsmokers versus ever-smokers (adjusted odds ratio [aOR], 1.041; 95% CI, 0.904-1.199; P=0.577). No differences in primary outcome were observed between former (aOR, 0.932; 95% CI, 0.791-1.178; P=0.399) or current smokers (aOR, 1.178; 95% CI, 0.970-1.431; P=0.098) versus nonsmokers. Subgroup analyses by race/ethnicity demonstrated no differences in primary outcome when former and current smokers were compared with nonsmokers. Former, but not current, smokers had a lower in-hospital mortality rate (aOR, 0.695; 95% CI, 0.500-0.968; P=0.031), which was only observed in Hispanics (aOR, 0.533; 95% CI, 0.309-0.921; P=0.024). Differences in self-reported health status measures were only observed in whites. Conclusions- Cigarette smoking history does not seem to provide a beneficial effect on 90-day functional outcome in patients with ICH.
背景与目的-尽管吸烟可能是导致脑出血（ICH）的一个风险因素，但动物模型表明，尼古丁具有潜在的神经保护作用。本多中心研究旨在确定吸烟史对 ICH 患者预后的影响。方法-我们对种族/种族变异颅内出血研究中前瞻性收集的数据进行了分析，并将吸烟状况数据纳入分析。患者被分为非吸烟者与曾吸烟者，后者进一步分为以前（ICH 前 30 天以上）或当前（ICH 前 30 天内）吸烟者。主要结局为 90 天改良 Rankin 量表评分变化分析。次要结局为住院死亡率和 90 天死亡率、Barthel 指数和自我报告的健康状况测量值。结果-总体研究队列包括 1509 名非吸烟者和 1423 名曾吸烟者（841 名以前吸烟者、577 名当前吸烟者、5 名未知）。非吸烟者与曾吸烟者的主要结局无差异（调整后优势比[OR]，1.041；95%置信区间[CI]，0.904-1.199；P=0.577）。以前吸烟者（OR，0.932；95%CI，0.791-1.178；P=0.399）或当前吸烟者（OR，1.178；95%CI，0.970-1.431；P=0.098）与非吸烟者相比，主要结局无差异。按种族/族裔亚组分析，以前和当前吸烟者与非吸烟者相比，主要结局无差异。以前而非当前吸烟者的住院死亡率较低（OR，0.695；95%CI，0.500-0.968；P=0.031），这仅在西班牙裔中观察到（OR，0.533；95%CI，0.309-0.921；P=0.024）。仅在白人中观察到自我报告的健康状况测量值的差异。结论-吸烟史似乎不能为 ICH 患者的 90 天功能结局提供有益影响。
