不明原因脑出血中的血肿扩大。
Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset.
机构信息
From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston.
出版信息
Neurology. 2021 May 11;96(19):e2363-e2371. doi: 10.1212/WNL.0000000000011895. Epub 2021 Apr 1.
OBJECTIVE
To investigate the prevalence, predictors, and prognostic effect of hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH) with unclear symptom onset (USO).
METHODS
We performed a retrospective analysis of patients with primary spontaneous ICH admitted at 5 academic medical centers in the United States and Italy. HE (volume increase >6 mL or >33% from baseline to follow-up noncontrast CT [NCCT]) and mortality at 30 days were the outcomes of interest. Baseline NCCT was also analyzed for presence of hypodensities (any hypodense region within the hematoma margins). Predictors of HE and mortality were explored with multivariable logistic regression.
RESULTS
We enrolled 2,165 participants, 1,022 in the development cohort and 1,143 in the replication cohort, of whom 352 (34.4%) and 407 (35.6%) had ICH with USO, respectively. When compared with participants having a clear symptom onset, patients with USO had a similar frequency of HE (25.0% vs 21.9%, = 0.269 and 29.9% vs 31.5%, = 0.423). Among patients with USO, HE was independently associated with mortality after adjustment for confounders (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.43-4.89, = 0.002). This finding was similar in the replication cohort (OR 3.46, 95% CI 1.86-6.44, < 0.001). The presence of NCCT hypodensities in patients with USO was an independent predictor of HE in the development (OR 2.59, 95% CI 1.27-5.28, = 0.009) and replication (OR 2.43, 95% CI 1.42-4.17, = 0.001) population.
CONCLUSION
HE is common in patients with USO and independently associated with worse outcome. These findings suggest that patients with USO may be enrolled in clinical trials of medical treatments targeting HE.
目的
探讨症状不明确（USO）的脑出血（ICH）患者血肿扩大（HE）的发生率、预测因素和预后影响。
方法
我们对美国和意大利的 5 所学术医疗中心收治的原发性自发性 ICH 患者进行了回顾性分析。感兴趣的结局为 30 天的 HE（体积增加>6mL 或基线至随访非对比 CT [NCCT]增加>33%）和死亡率。还对基线 NCCT 进行了有无低密度影（血肿边界内的任何低密度区域）的分析。采用多变量逻辑回归探讨 HE 和死亡率的预测因素。
结果
我们共纳入了 2165 名参与者，其中发展队列 1022 名，复制队列 1143 名，分别有 352 名（34.4%）和 407 名（35.6%）患者 ICH 症状不明确。与有明确症状发作的患者相比，症状不明确的患者 HE 发生率相似（25.0%比 21.9%，=0.269 和 29.9%比 31.5%，=0.423）。在校正混杂因素后，症状不明确患者的 HE 与死亡率独立相关（优势比 [OR] 2.64，95%置信区间 [CI] 1.43-4.89，=0.002）。这一发现与复制队列相似（OR 3.46，95%CI 1.86-6.44，<0.001）。症状不明确患者 NCCT 低密度影的存在是发展（OR 2.59，95%CI 1.27-5.28，=0.009）和复制（OR 2.43，95%CI 1.42-4.17，=0.001）队列中 HE 的独立预测因素。
结论
HE 在症状不明确的患者中较为常见，且与预后不良独立相关。这些发现表明，症状不明确的患者可能被纳入针对 HE 的医学治疗临床试验。
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