Hegde Ajay, Menon Girish, Kumar Vinod, Lakshmi Prasad G, Kongwad Lakshman I, Nair Rajesh, Nayak Raghavendra
Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, UK.
Stroke Res Treat. 2020 Jan 27;2020:2192709. doi: 10.1155/2020/2192709. eCollection 2020.
This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Prospective data collection and analysis of patients with SICH admitted to our centre between 1 January 2015 and 31 December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% ( = 190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3-month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0-3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4-5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 ( = <0.001, OR 4.806, 95% CI 3.064-7.54), admission GCS <8 ( = <0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml ( = <0.001, OR 2.45, 95% CI 1.626-3.691). Intraventricular haemorrhage was an additional poor outcome predictor ( < 0.015, CI 1.105-2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.
本文旨在评估印度南部人群高血压性脑出血后的临床特征及预后决定因素。该研究是印度单一中心报道的最大规模的脑出血系列研究。对2015年1月1日至2018年12月31日期间入住我们中心的脑出血患者进行前瞻性数据收集和分析。分析的变量包括：年龄、性别、合并症、入院时的格拉斯哥昏迷评分（GCS）、影像学特征、治疗方式以及三个月时的预后。采用改良Rankin评分（mRS）评估出院时及三个月时的预后。我们的研究组有905例患者，其中男性638例，女性267例，就诊时的平均年龄为58.10±12.76岁。研究组包括523例（57.8%）先前诊断为高血压的患者，其中36.3%（=190）未规律服药。血肿最常见的部位是基底节（478例）、丘脑（202例）、脑叶（106例）、小脑（61例）、脑干（31例）和原发性脑室内出血（27例）。入院时425例（47%）患者出现继发性脑室扩展。入院时血凝块的平均体积为23.45±19.79ml，仅46例（5.08%）出现血凝块进展。147例（16.8%）患者通过开颅手术进行手术清除血肿，56例（6.2%）患者进行了脑室外引流（EVD）。总体三个月死亡率为30.1%（266例患者）。在最后一次随访中，412例（45.53%）患者预后良好（mRS 0 - 3），207例（22.87%）患者预后不良（mRS 4 - 5）。死亡率的独立预测因素为年龄>70岁（= <0.001，OR 4.806，95% CI 3.064 - 7.54）、入院GCS <8（= <0.001，OR7.684，95% CI 5.055–11.68）以及血肿体积>30ml（= <0.001，OR 2.45，95% CI 1.626 - 3.691）。脑室内出血是另一个预后不良的预测因素（<0.015，CI 1.105 - 2.585）。手术清除血肿降低了该组的死亡率，但发病率保持不变。与西方社会相比，脑出血在印度主要影响较年轻的人群。老年、入院时GCS差、血凝块体积超过30ml和脑室扩展仍然是死亡和预后不良最一致的预测因素。需要进一步研究评估高血压患者脑出血的风险，并使用包括生物标志物在内的新预测因素预测脑出血后的预后。
