Martinez Joana, Mouzinho Maria, Teles Joana, Guilherme Patrícia, Nogueira Jerina, Félix Catarina, Ferreira Fátima, Marreiros Ana, Nzwalo Hipólito
Faculty of Medicine and Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
Neurology Department, Centro Hospitalar Universitário do Algarve, Algarve, Portugal.
Clin Neurol Neurosurg. 2020 Apr;191:105696. doi: 10.1016/j.clineuro.2020.105696. Epub 2020 Jan 30.
The case fatality from spontaneous ICH (SICH) remains high. The quality and intensity of early treatment is one of the determinants of the outcome. We aimed to study the association of early intensive care, using the Intracerebral Hemorrhage-Specific Intensity of Care Quality Metrics (IHSICQM) with the 30-day in-hospital mortality in Algarve, Portugal.
analysis of prospective collected data of 157 consecutive SICH patients (2014-2016). Logistic regression was performed to assess the role of IHSICQM on the 30-day in-hospital mortality controlling for the most common clinical and radiological predictors of death. Receiver operating characteristic (ROC) curve was developed to evaluate the prediction accuracy of the IHSICQM score (C-statistics).
forty-five (29 %) patients died. The group of deceased patients had lower intensity of care (lower IHSICQM score) and higher proportion of poor prognosis associated factors (pre-ICH functional dependency, intraventricular dissection/glycaemia). On the multivariate analysis, higher IHSICQM was associated with reduction of the odds of death, 0.27 (0.14-0.50) per each increasing point. The ROC curve showed a high discriminating ability of isolated IHSICQM in predicting the 30-day mortality (AUC = 0,95; 95 % CI = [0,86; 0,95]).
the early intensity of quality of care independently predicts the 30-day in-hospital mortality. Quantification of the intensity of SICH is a valid tool to persuade improvement of SICH care, as well to help comparison of performances within and between hospitals.
自发性脑出血（SICH）的病死率仍然很高。早期治疗的质量和强度是预后的决定因素之一。我们旨在研究使用脑出血特异性护理质量指标强度（IHSICQM）的早期重症监护与葡萄牙阿尔加维地区30天院内死亡率之间的关联。
对157例连续的SICH患者（2014 - 2016年）的前瞻性收集数据进行分析。进行逻辑回归以评估IHSICQM在控制最常见的临床和放射学死亡预测因素时对30天院内死亡率的作用。绘制受试者工作特征（ROC）曲线以评估IHSICQM评分的预测准确性（C统计量）。
45例（29%）患者死亡。死亡患者组的护理强度较低（IHSICQM评分较低），且预后不良相关因素的比例较高（脑出血前功能依赖、脑室内出血/血糖）。在多变量分析中，IHSICQM越高，死亡几率降低，每增加一个点，死亡几率为0.27（0.14 - 0.50）。ROC曲线显示，单独的IHSICQM在预测30天死亡率方面具有较高的辨别能力（AUC = 0.95；95%CI = [0.86；0.95]）。
早期护理质量强度独立预测30天院内死亡率。SICH护理强度的量化是促进SICH护理改善的有效工具，也有助于医院内部和医院之间的绩效比较。
