Yamashita Ayuko, Kitamura Mineaki, Tateishi Yohei, Torigoe Kenta, Muta Kumiko, Mochizuki Yasushi, Izumo Tsuyoshi, Matsuo Takayuki, Tsujino Akira, Sakai Hideki, Mukae Hiroshi, Nishino Tomoya
Division of Blood Purification, Nagasaki University Hospital, Japan.
Department of Nephrology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Japan.
Intern Med. 2022 Apr 15;61(8):1133-1138. doi: 10.2169/internalmedicine.8006-21. Epub 2021 Sep 25.
Objective The quality of life and activities of daily living (ADL) are generally poor among dialysis patients after intracerebral hemorrhaging, and their precise clinical course remains unclear. In addition, the association between the severity of cerebral hemorrhaging and the long-term prognosis in these patients has not been fully elucidated. This study aimed to evaluate the subsequent prognosis of hemodialysis patients who survived the acute phase of intracerebral hemorrhaging. Methods We included hemodialysis patients who were admitted to Nagasaki University Hospital between 2007 and 2015 for intracerebral hemorrhaging treatment. After excluding cases of in-hospital death, survivors were classified using the 5-point modified Rankin Scale (mRS), which specifically measures the ADL in patients with cerebrovascular diseases. The patients were followed up at the medical facilities to which they were transferred in the same medical zone until 2017. Results Out of 91 patients with cerebral hemorrhaging (65±11 years old, 66% men, hemodialysis duration 108±91 months), 62 survived until discharge. Twenty-one patients died during observation, largely due to infectious diseases, such as sepsis and pneumonia (n=16, 76%). Compared to patients with mRS 0-4 (n=31), those with mRS 5 (n=31) showed a significantly poorer prognosis. The hazard ratio adjusted for age and antiplatelets was 13.7 (95% confidence interval: 3.88-63.7, p<0.001). Conclusion Hemodialysis patients with intracerebral hemorrhaging who were bedridden showed poor outcomes. The major causes of death were infections. Therefore, these patients should be carefully monitored for infections in order to improve their prognosis.
目的 脑出血后透析患者的生活质量和日常生活活动能力（ADL）普遍较差，其确切临床病程尚不清楚。此外，这些患者脑出血严重程度与长期预后之间的关联尚未完全阐明。本研究旨在评估脑出血急性期存活的血液透析患者的后续预后。方法 我们纳入了2007年至2015年间因脑出血治疗入住长崎大学医院的血液透析患者。排除院内死亡病例后，使用5分改良Rankin量表（mRS）对幸存者进行分类，该量表专门用于测量脑血管疾病患者的ADL。患者在同一医疗区域内转至的医疗机构接受随访至2017年。结果 在91例脑出血患者（65±11岁，男性66%，血液透析时间108±91个月）中，62例存活至出院。21例患者在观察期间死亡，主要原因是败血症和肺炎等传染病（n = 16，76%）。与mRS 0 - 4的患者（n = 31）相比，mRS 5的患者（n = 31）预后明显较差。经年龄和抗血小板药物调整后的风险比为13.7（95%置信区间：3.88 - 63.7，p < 0.001）。结论 脑出血后卧床的血液透析患者预后较差。主要死亡原因是感染。因此，应密切监测这些患者的感染情况以改善其预后。
