Lee Kun He, Lioutas Vasileios-Arsenios, Marchina Sarah, Selim Magdy
Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA.
Neurocrit Care. 2022 Oct;37(2):455-462. doi: 10.1007/s12028-022-01532-0. Epub 2022 Jun 8.
Conflicting data exist regarding the association of perihematomal edema (PHE) with outcomes after intracerebral hemorrhage (ICH). We performed a post hoc analysis of the ICH Deferoxamine trial to examine whether an early change in ventricular size (VS), as a composite measure of PHE growth and mass effect, intraventricular hemorrhage, and hydrocephalus, is a more accurate predictor of outcome than PHE measures alone.
Computerized tomography scans were performed at baseline and after 72-96 h. We evaluated measures of PHE and change in VS as predictors of outcome, assessed by a dichotomized modified Rankin Scale score (0-2 versus 3-6), primarily at 90 days and secondarily at 30 days. A multivariable logistic regression model was fitted for each predictor, with adjustment for the same confounders.
A total of 248 participants were included after we excluded those requiring external ventricular drains. On univariate analyses, older age, female sex, lower Glasgow Coma Scale score and baseline temperature, greater ICH volume, absolute PHE volume, edema extension distance at presentation, lesser changes in relative PHE volume and edema extension distance, and an increase in VS were associated with poor outcome. In multivariable analyses, only the increase in VS was associated with lower odds of modified Rankin Scale scores 0-2 at 90 days (odds ratio 0.927, 95% confidence interval 0.866-0.970, p = 0.001) and 30 days (odds ratio 0.931, 95% confidence interval 0.888-0.975, p = 0.003).
Within the context of a randomized controlled trial with standardized imaging and functional assessments, we did not find significant associations between measures of PHE and outcome but documented an independent association between early increase in VS and lower odds of good clinical outcome.
关于脑出血（ICH）后血肿周围水肿（PHE）与预后的关联，存在相互矛盾的数据。我们对 ICH 去铁胺试验进行了事后分析，以检验作为 PHE 生长、占位效应、脑室内出血和脑积水综合指标的脑室大小（VS）早期变化，是否比单独的 PHE 指标更能准确预测预后。
在基线和 72 - 96 小时后进行计算机断层扫描。我们评估了 PHE 指标和 VS 变化作为预后预测指标，主要通过二分法改良 Rankin 量表评分（0 - 2 与 3 - 6）进行评估，主要在 90 天时进行，次要在 30 天时进行。针对每个预测指标拟合多变量逻辑回归模型，并对相同的混杂因素进行调整。
在排除需要外置脑室引流管的患者后，共纳入 248 名参与者。单因素分析显示，年龄较大、女性、格拉斯哥昏迷量表评分较低和基线体温较低、脑出血体积较大、绝对 PHE 体积、就诊时水肿扩展距离、相对 PHE 体积和水肿扩展距离变化较小以及 VS 增加与预后不良相关。在多变量分析中，仅 VS 增加与 90 天时改良 Rankin 量表评分 0 - 2 的较低几率相关（比值比 0.927，95%置信区间 0.866 - 0.970，p = 0.001）以及 30 天时相关（比值比 0.931，95%置信区间 0.888 - 0.975，p = 0.003）。
在具有标准化影像学和功能评估的随机对照试验背景下，我们未发现 PHE 指标与预后之间存在显著关联，但记录了 VS 早期增加与良好临床预后较低几率之间的独立关联。
