Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, No. 12 Mid. Wulumuqi Road, Shanghai, 200040, China.
Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120, China.
Neurocrit Care. 2019 Dec;31(3):455-465. doi: 10.1007/s12028-019-00754-z.
Early hematoma expansion in intracerebral hemorrhage (ICH) patients is associated with poor outcome. We aimed to investigate whether the minimal computed tomography (CT) attenuation value predicted hematoma expansion and poor outcome.
This study involved spontaneous ICH patients of two cohorts who underwent baseline CT scan within 6 h after ICH onset and follow-up CT scan within 24 h after initial CT scan. We determined the critical value of the minimal CT attenuation value via retrospective analysis of the data from a derivation cohort. Then, a prospective study on the validation cohort of three clinical centers was performed for determining the association between the minimal CT attenuation value and hematoma expansion as well as poor outcome (modified Rankin Scale scores > 3) at 90 days by using univariate and multivariate logistic regression analyses.
One hundred and forty eight ICH patients were included in the derivation cohort. Minimal CT attenuation value ≤ 31 Hounsfield units (HU) was demonstrated as the critical value to predict hematoma expansion by using receiver operating characteristic analysis. A total of 311 ICH patients were enrolled in the validation cohort, 86 (27.7%) and 133 (42.8%) of which were found hematoma expansion and poor outcome. Minimal CT attenuation value ≤ 31 HU was positive in 73 patients (23.5%). The multivariate logistic regression analysis demonstrated minimal CT attenuation value and minimal CT attenuation value ≤ 31 HU independently predicted hematoma expansion (p < 0.001) and poor outcome (p < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of minimal CT attenuation value ≤ 31 HU for hematoma expansion and poor outcome prediction were 64.0, 92.0, 75.3, 87.0, 84.2 and 45.1%, 92.7%, 82.2%, 69.3%, 72.3%, respectively.
The minimal CT attenuation value independently predicts early hematoma expansion and poor outcome in patients with ICH.
脑出血（ICH）患者早期血肿扩大与不良预后相关。我们旨在研究最小 CT 衰减值是否可预测血肿扩大和不良预后。
本研究纳入了两个队列的自发性 ICH 患者，他们在 ICH 发病后 6 小时内行基线 CT 扫描，并在首次 CT 扫描后 24 小时内行随访 CT 扫描。我们通过回顾性分析来自一个推导队列的数据确定了最小 CT 衰减值的临界值。然后，我们在三个临床中心的验证队列中进行了一项前瞻性研究，通过单变量和多变量逻辑回归分析确定最小 CT 衰减值与血肿扩大以及 90 天时不良预后（改良 Rankin 量表评分>3）之间的关系。
在推导队列中纳入了 148 例 ICH 患者。使用受试者工作特征分析显示，最小 CT 衰减值≤31 亨斯菲尔德单位（HU）是预测血肿扩大的临界值。在验证队列中纳入了 311 例 ICH 患者，其中 86 例（27.7%）和 133 例（42.8%）发生了血肿扩大和不良预后。在 73 例患者中，最小 CT 衰减值≤31 HU 呈阳性（23.5%）。多变量逻辑回归分析表明，最小 CT 衰减值和最小 CT 衰减值≤31 HU 独立预测血肿扩大（p<0.001）和不良预后（p<0.001）。最小 CT 衰减值≤31 HU 预测血肿扩大和不良预后的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 64.0%、92.0%、75.3%、87.0%和 84.2%和 45.1%、92.7%、82.2%、69.3%、72.3%。
最小 CT 衰减值独立预测 ICH 患者的早期血肿扩大和不良预后。
