Garg Aayushi, Rocha Marcelo, Starr Matthew, Ortega-Gutierrez Santiago
Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America.
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
J Neurol Sci. 2021 Feb 15;421:117312. doi: 10.1016/j.jns.2021.117312. Epub 2021 Jan 7.
Intracranial hemorrhage (ICH) is the most common neurologic complication of reversible cerebral vasoconstriction syndrome (RCVS). In this study, we compared hemorrhagic and non-hemorrhagic RCVS with an aim to evaluate the risk factors and short-term clinical outcomes of hemorrhagic lesions.
We used the Nationwide Readmissions Database 2016-2017 to identify all hospitalizations due to RCVS. Predictors and clinical outcomes of ICH were analyzed using logistic regression analysis.
Among the total 1834 hospitalizations for RCVS during the study period (mean ± SD age:48.4 ± 15.6 years, female:75.8%), 768 (41.9%) had occurrence of ICH. Patients with ICH were more likely to be female (OR:2.72, 95% CI:1.86-3.97), have a history of hypertension (OR:1.63, 95% CI:1.20-2.22) and cocaine use (OR:3.11, 95% CI:1.49-6.51), and were less likely to have a history of diabetes (OR:0.52, 95% CI:0.32-0.84) and heart failure (OR:0.34, 95% CI:0.14-0.84). Hemorrhagic RCVS was associated with higher odds of cerebral edema (OR:10.71, 95% CI:5.75-19.97), new onset seizure (OR:2.24, 95% CI:1.08-4.61), respiratory failure (OR:2.40, 95% CI:1.37-4.22) and gastrostomy tube placement (OR:3.20, 95% CI:1.07-9.58). Patients with hemorrhagic lesions also had longer length of hospital stay (mean difference 5.5 days), higher hospital charges (mean difference $105,547), and a lower likelihood of discharge to home (OR:0.61, 95% CI:0.43-0.86). There was, however, no significant difference in the in-hospital mortality.
ICH affects nearly 42% of patients with RCVS and is associated with increased rate of other neurologic complications and adverse discharge disposition, thus putting into question the prevailing conception that RCVS is generally a benign disorder with a self-limiting clinical course.
颅内出血（ICH）是可逆性脑血管收缩综合征（RCVS）最常见的神经系统并发症。在本研究中，我们比较了出血性和非出血性RCVS，旨在评估出血性病变的危险因素和短期临床结局。
我们使用2016 - 2017年全国再入院数据库来识别所有因RCVS住院的患者。使用逻辑回归分析来分析ICH的预测因素和临床结局。
在研究期间的1834例RCVS住院患者中（平均年龄±标准差：48.4±15.6岁，女性：75.8%），768例（41.9%）发生了ICH。ICH患者更可能为女性（比值比：2.72，95%置信区间：1.86 - 3.97），有高血压病史（比值比：1.63，95%置信区间：1.20 - 2.22）和使用可卡因史（比值比：3.11，95%置信区间：1.49 - 6.51），且不太可能有糖尿病病史（比值比：0.52，95%置信区间：0.32 - 0.84）和心力衰竭病史（比值比：0.34，95%置信区间：0.14 - 0.84）。出血性RCVS与脑水肿几率更高（比值比：10.71，95%置信区间：5.75 - 19.97）、新发癫痫（比值比：2.24，95%置信区间：1.08 - 4.61）、呼吸衰竭（比值比：2.40，95%置信区间：1.37 - 4.22）和胃造瘘管置入（比值比：3.20，95%置信区间：1.07 - 9.58）相关。有出血性病变的患者住院时间也更长（平均差异5.5天），住院费用更高（平均差异105547美元），出院回家的可能性更低（比值比：0.61，95%置信区间：0.43 - 0.86）。然而，住院死亡率没有显著差异。
ICH影响近42%的RCVS患者，并与其他神经系统并发症发生率增加和不良出院处置相关，因此对RCVS通常是具有自限性临床病程的良性疾病这一普遍观念提出了质疑。
