Mc Lernon Siobhan, Schwarz Ghil, Wilson Duncan, Ambler Gareth, Goodwin Russell, Shakeshaft Clare, Cohen Hannah, Yousry Tarek, Al-Shahi Salman Rustam, Lip Gregory Y H, Houlden Henry, Brown Martin M, Muir Keith W, Jäger Hans Rolf, Terry Louise, Werring David J
Stroke Research Centre, University College London, Institute of Neurology, London, UK; London South Bank University, School of Health and Social Care, London, UK.
Stroke Research Centre, University College London, Institute of Neurology, London, UK; Department of Neurology, Stroke Unit San Raffaele Hospital, Milan, Italy.
J Neurol Sci. 2020 Nov 15;418:117141. doi: 10.1016/j.jns.2020.117141. Epub 2020 Sep 19.
There is uncertainty about the clinical benefit of admission to critical care after spontaneous intracerebral haemorrhage (ICH).
We investigated factors associated with critical care admission after spontaneous ICH and evaluated associations between critical care and 6-month functional outcome.
We included 825 patients with acute spontaneous non-traumatic ICH, recruited to a prospective multicenter observational study. We evaluated the characteristics associated with critical care admission and poor 6-month functional outcome (modified Rankin Scale, mRS > 3) using univariable (chi-square test and Wilcoxon rank-sum test, as appropriate) and multivariable analysis.
286 patients (38.2%) had poor 6-month functional outcome. Seventy-seven (9.3%) patients were admitted to critical care. Patients admitted to critical care were younger (p < 0.001), had lower GCS score (p < 0.001), larger ICH volume (p < 0.001), more often had intraventricular extension (p = 0.008) and underwent neurosurgery (p < 0.001). Critical care admission was associated with poor functional outcome at 6 months (39/77 [50.7%] vs 286/748 [38.2%]; p = 0.034); adjusted OR 2.43 [95%CI 1.36-4.35], p = 0.003), but not with death (OR 1.29 [95%CI 0.71-2.35; p = 0.4). In ordinal logistic regression, patients admitted to critical care showed an OR 1.47 (95% CI 0.98-2.20; p = 0.07) for a shift in the 6-month modified Rankin Scale.
Admission to critical care is associated with poor 6-month functional outcome after spontaneous ICH but not with death. Patients admitted to critical care were a priori more severely affected. Although adjusted for main known predictors of poor outcome, our findings could still be confounded by unmeasured factors. Establishing the true effectiveness of critical care after ICH requires a randomised trial with clinical outcomes and quality of life assessments.
自发性脑出血（ICH）后入住重症监护病房的临床益处尚不确定。
我们调查了自发性ICH后入住重症监护病房的相关因素，并评估了重症监护与6个月功能结局之间的关联。
我们纳入了825例急性自发性非创伤性ICH患者，这些患者来自一项前瞻性多中心观察性研究。我们使用单变量分析（适当情况下采用卡方检验和Wilcoxon秩和检验）和多变量分析评估了与入住重症监护病房及6个月功能结局不良（改良Rankin量表，mRS＞3）相关的特征。
286例患者（38.2%）6个月功能结局不良。77例（9.3%）患者入住重症监护病房。入住重症监护病房的患者更年轻（p＜0.001），格拉斯哥昏迷量表（GCS）评分更低（p＜0.001），脑出血体积更大（p＜0.001），更常出现脑室扩展（p = 0.008）且接受了神经外科手术（p＜0.001）。入住重症监护病房与6个月时功能结局不良相关（39/77 [50.7%] 对比286/748 [38.2%]；p = 0.034）；校正后的比值比（OR）为2.43 [95%置信区间（CI）1.36 - 4.35]，p = 0.003），但与死亡无关（OR 1.29 [95%CI 0.71 - 2.35；p = 0.4]）。在有序逻辑回归中，入住重症监护病房的患者6个月改良Rankin量表出现变化的OR为1.47（95%CI 0.98 - 2.20；p = 0.07）。
自发性ICH后入住重症监护病房与6个月功能结局不良相关，但与死亡无关。入住重症监护病房的患者预先受到的影响更严重。尽管对已知的不良结局主要预测因素进行了校正，但我们的研究结果仍可能受到未测量因素的混淆。确定ICH后重症监护的真正有效性需要一项包含临床结局和生活质量评估的随机试验。
