Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Internal Medicine, North Denmark Regional Hospital, Hjørring, Denmark.
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.
Thromb Res. 2020 Jul;191:1-8. doi: 10.1016/j.thromres.2020.03.024. Epub 2020 Apr 21.
Intracerebral hemorrhage is a devastating vascular event. Clinical factors prognostic of recurrence facilitating individualized post-bleeding patient management are sparsely described. We aimed to describe incidence of recurrence of intracerebral hemorrhage and explore the prognostic value of 25 clinical characteristics in patients with and without atrial fibrillation.
Cohort study of patients with incident intracerebral hemorrhage diagnosed from 2003 to 2016 identified using nationwide Danish administrative registries. Results reported as cumulative incidence of intracerebral recurrence accounting for competing risk of death. Univariate and multivariate prognostic factors for recurrence estimated using Cox regression (hazard ratios [HRs], 95% confidence intervals [CI]).
We identified 9255 patients with incident intracerebral hemorrhage (median age 73 years, 46.6% females, 16% with atrial fibrillation). Five-year risks of recurrence of intracerebral hemorrhage were approximately 10% in the study population, although slightly higher for patients without atrial fibrillation. Prognostic factors for recurrence were broadly similar for patients with and without atrial fibrillation. Age in categories <60 years (reference), age 60-70 years (HR 1.29, 95% CI 1.02-1.64), age 70-80 years (HR 1.59, 95% CI 1.26-2.00), age >80 years (HR 1.19, 95% CI 0.91-1.55), nursing home residency (HR 1.48, 95% CI 1.02-2.13), and Scandinavian Stroke Scale score ('mild' versus 'moderate' (HR 1.40, 95% CI 1.13-1.72) and 'severe' (HR 1.96, 95% CI 1.61-2.39)) were the strongest prognostic factors.
Risk of recurrence of intracerebral hemorrhage after five years was approximately 10%. Clinical characteristics associated with recurrence were few and broadly similar for patients with and without atrial fibrillation, with age and measure of incident bleeding severity, as reflected by Scandinavian Stroke Scale score, being the most important.
脑出血是一种破坏性的血管事件。目前对于能够预测再出血的临床因素的研究较少，而这些因素有助于对出血后患者进行个体化管理。本研究旨在描述脑出血患者的再出血发生率，并探讨伴有和不伴有心房颤动的患者中 25 种临床特征的预后价值。
本研究为一项基于全国丹麦行政登记系统的脑出血患者的队列研究。结果以考虑死亡竞争风险的脑出血再发累积发生率报告。使用 Cox 回归（风险比[HR]，95%置信区间[CI]）对再发的单变量和多变量预后因素进行估计。
本研究共纳入 9255 例脑出血患者（中位年龄 73 岁，46.6%为女性，16%伴有心房颤动）。研究人群的脑出血再发 5 年风险约为 10%，但无心房颤动患者的风险略高。伴有和不伴有心房颤动的患者的再发预后因素大致相似。<60 岁（参考）、60-70 岁（HR 1.29，95%CI 1.02-1.64）、70-80 岁（HR 1.59，95%CI 1.26-2.00）、>80 岁（HR 1.19，95%CI 0.91-1.55）、养老院居住（HR 1.48，95%CI 1.02-2.13）和斯堪的纳维亚卒中量表评分（“轻度”与“中度”（HR 1.40，95%CI 1.13-1.72）和“重度”（HR 1.96，95%CI 1.61-2.39））是最强的预后因素。
脑出血患者五年后的再发风险约为 10%。与再出血相关的临床特征较少，且在伴有和不伴有心房颤动的患者中大致相似，最重要的是年龄和斯堪的纳维亚卒中量表评分所反映的出血严重程度。
