Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, Japan.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):105001. doi: 10.1016/j.jstrokecerebrovasdis.2020.105001. Epub 2020 Jun 13.
Individual cerebral small vessel disease (SVD) markers are independent predictors for poor prognosis following intracerebral hemorrhage (ICH), however, the impact of the cumulative SVD burden on outcomes remains unclear. We aimed to investigate the association between the global SVD burden and functional outcomes following ICH.
We retrospectively evaluated a consecutive cohort of patients with ICH who underwent brain magnetic resonance imaging and magnetic resonance angiography, from a prospective registry. We identified the presence and severity of the SVD markers (cerebral microbleeds, lacunar infarctions, periventricular hyperintensities, and deep white matter hyperintensities) and summed them to obtain the modified total SVD score (0-4). Poor functional outcomes were defined as a modified Rankin Scale score at discharge ≥ 3. A multivariate logistic regression model was used to assess the association between patient outcomes and the SVD score.
A total of 144 patients were included (65.0 ± 12.2 years, 67.4% male). The modified total SVD score was potentially associated with poor functional outcomes (odds ratio [OR] 1.72, 95% confidence interval [CI] 0.97-3.03) after adjustment for age, sex, history of stroke, chronic kidney disease, prior use of antithrombotic agents, the National Institutes of Health Stroke Scale score on admission, the non-lobar location of ICH, and hematoma volume on admission. Moreover, among older patients (≥ 65 years), the SVD score was associated with poor outcomes (OR 3.11, 95% CI 1.01-9.55). Among those with supratentorial ICH, the score remained significant (OR 2.06, 95% CI 1.11-3.83).
The modified total SVD score may have predictive value for poor functional outcomes following ICH.
个体脑小血管病（SVD）标志物是脑出血（ICH）后预后不良的独立预测因素，但 SVD 负担的累积对结局的影响尚不清楚。我们旨在研究 SVD 总负担与 ICH 后功能结局之间的关系。
我们回顾性评估了来自前瞻性登记的连续ICH 患者的脑磁共振成像和磁共振血管造影。我们确定了 SVD 标志物（脑微出血、腔隙性梗死、脑室周围高信号和深部白质高信号）的存在和严重程度，并将其相加得到改良的总 SVD 评分（0-4）。功能结局不良定义为出院时改良Rankin 量表评分≥3 分。使用多变量逻辑回归模型评估患者结局与 SVD 评分之间的关系。
共纳入 144 例患者（65.0±12.2 岁，67.4%为男性）。校正年龄、性别、卒中史、慢性肾脏病、抗栓药物使用史、入院时 NIHSS 评分、ICH 非叶性部位和入院时血肿体积后，改良总 SVD 评分与不良功能结局相关（优势比[OR]1.72，95%置信区间[CI]0.97-3.03）。此外，在年龄较大的患者（≥65 岁）中，SVD 评分与不良结局相关（OR 3.11，95%CI 1.01-9.55）。在幕上 ICH 患者中，评分仍具有显著意义（OR 2.06，95%CI 1.11-3.83）。
改良的总 SVD 评分可能对 ICH 后不良功能结局具有预测价值。
