Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China.
Department of Cardiology, PLA Rocket Force Characteristic Medical Center, Beijing 100088, PR China..
J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105950. doi: 10.1016/j.jstrokecerebrovasdis.2021.105950. Epub 2021 Jun 30.
Redefined hematoma expansion (rHE) including intraventricular hematoma expansion (IVHE) is a new concept in intracerebral hemorrhage (ICH), with better prognostic ability compared to the conventional hematoma expansion. Ultraearly hematoma growth (uHG) and computed tomography angiography (CTA) spot sign are both useful indictors to predict HE and poor clinical outcome. This study aims to explore the clinical characteristics of rHE in retrospective cohort and evaluate the predictive ability of uHG and spot sign in rHE.
This study included nontraumatic spontaneous ICH patients from June 1 2013 and January 1 2018 in West China Hospital. Multivariate logistic regression was used to determine risk factors for HE/IVHE/rHE and primary outcomes of ICH patients. Receiver operating characteristic (ROC) analysis was performed to assess the accuracy of uHG and spot sign for predicting HE/IVHE/rHE.
This retrospective cohort included 469 consecutive patients with ICH. rHE was significantly associated with clinical variables including Glasgow coma scale (GCS), time to initial CT, presence of IVH, hematoma volume, presence of spot sign, and uHG. uHG and spot sign were independent risk factors for rHE. ROC analysis indicated that both uHG (AUC 0.726, 95%CI 0.680-0.773) and spot sign (AUC 0.735, 95%CI 0.686-0.785) possessed high predictive accuracy for rHE. HE and rHE were independent risk factors for 1-month mortality and 3-month functional outcome.
Both uHG and the spot sign were considered to be good predictors for rHE, and the spot sign appeared to have a better predictive accuracy.
重新定义的血肿扩大（rHE）包括脑室内血肿扩大（IVHE）是脑出血（ICH）的新概念，与传统的血肿扩大相比具有更好的预后能力。超早期血肿增长（uHG）和计算机断层血管造影（CTA）斑点征都是预测 HE 和不良临床结局的有用指标。本研究旨在探讨回顾性队列中 rHE 的临床特征，并评估 uHG 和斑点征在 rHE 中的预测能力。
本研究纳入了 2013 年 6 月 1 日至 2018 年 1 月 1 日期间在华西医院就诊的非创伤性自发性 ICH 患者。多变量逻辑回归用于确定 HE/IVHE/rHE 的危险因素和 ICH 患者的主要结局。接收者操作特征（ROC）分析用于评估 uHG 和斑点征预测 HE/IVHE/rHE 的准确性。
本回顾性队列纳入了 469 例连续 ICH 患者。rHE 与临床变量显著相关，包括格拉斯哥昏迷量表（GCS）、初始 CT 时间、IVH 存在、血肿体积、斑点征和 uHG 存在。uHG 和斑点征是 rHE 的独立危险因素。ROC 分析表明，uHG（AUC 0.726，95%CI 0.680-0.773）和斑点征（AUC 0.735，95%CI 0.686-0.785）对 rHE 均具有较高的预测准确性。HE 和 rHE 是 1 个月死亡率和 3 个月功能结局的独立危险因素。
uHG 和斑点征均被认为是 rHE 的良好预测指标，而斑点征似乎具有更好的预测准确性。
