Warren Andrew D, Li Qi, Schwab Kristin, McKaig Brenna, Goldstein Alexa N, Greenberg Steven M, Viswanathan Anand, Anderson Christopher, Gurol M Edip, Patel Aman, Goldstein Joshua N
Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Int J Emerg Med. 2022 Sep 15;15(1):51. doi: 10.1186/s12245-022-00450-4.
Many patients with intracerebral hemorrhage (ICH) develop intraventricular hemorrhage (IVH), which is associated with higher mortality and worse clinical outcome. External ventricular drains (EVDs) are often placed, but there is little data on how much patients benefit from this intervention. We explored the use, timing, and location of EVD in ICH patients and any association with clinical outcome.
During the study period, 2870 patients presented with primary ICH, and 2486 were included in analyses. Overall, patients were 73 (± 13) years old; 54% were male, and 46% had associated IVH. An EVD was placed in 29% of patients with IVH and 4% of those without. IVH patients with EVD were younger (67 ± 13 vs 74 ± 13, p < 0.001), had larger IVH volumes (17 mL vs 8 mL, p < 0.001), and lower GCS scores (7 vs 10, p < 0.001), compared to those without EVD. Ninety-day mortality was available in 2486 (100%) patients, while 90-day mRS was available in 1673 (67.3%). In univariate analysis, EVD placement was associated with lower likelihood of 90-day mortality (53% vs 59%, p = 0.048) but higher likelihood of poor outcome (88% vs 85%, p < 0.001) in those for whom this was available. Those with poor outcomes underwent faster EVD placement (0.46 days vs. 0.96 days, p = 0.01). In multivariate analysis, EVD placement was associated with lower 90-day mortality (OR 0.19, 95% CI 0.053-0.657, p = 0.009), but not with lower odds of poor outcome (OR 1.64, 95% CI 0.508-5.309, p = 0.4). In multivariate analysis, days to EVD placement was associated with lower 90-day mortality (OR 0.69, 95% CI 0.49-0.96, p = 0.027).
IVH is relatively common after ICH. After controlling for potential confounds, EVD placement is associated with lower mortality, but not clearly with better neurologic outcome. In addition, more rapid EVD placement is associated with higher mortality, potentially reflecting early development of herniation or obstructive hydrocephalus.
许多脑出血（ICH）患者会发生脑室出血（IVH），这与更高的死亡率和更差的临床结局相关。常放置外部脑室引流管（EVD），但关于患者从该干预措施中获益程度的数据很少。我们探讨了EVD在ICH患者中的使用、时机和位置以及与临床结局的任何关联。
在研究期间，2870例患者出现原发性ICH，2486例纳入分析。总体而言，患者年龄为73（±13）岁；54%为男性，46%伴有IVH。29%的IVH患者和4%的无IVH患者放置了EVD。与未放置EVD的IVH患者相比，放置EVD的患者更年轻（67±13岁对74±13岁，p<0.001），IVH体积更大（17 mL对8 mL，p<0.001），格拉斯哥昏迷量表（GCS）评分更低（7分对10分，p<0.001）。2486例（100%）患者有90天死亡率数据，1673例（67.3%）患者有90天改良Rankin量表（mRS）数据。单因素分析中，对于可获得该数据的患者，放置EVD与90天死亡率较低相关（53%对59%，p=0.048），但与不良结局可能性较高相关（88%对85%，p<0.001）。结局不良的患者EVD放置更快（0.46天对0.96天，p=0.01）。多因素分析中，放置EVD与90天死亡率较低相关（比值比[OR]0.19，95%置信区间[CI]0.053 - 0.657，p=0.009），但与不良结局几率较低无关（OR 1.64，95%CI 0.508 - 5.309，p=0.4）。多因素分析中，至EVD放置的天数与90天死亡率较低相关（OR 0.69，95%CI 0.49 - 0.96，p=0.027）。
ICH后IVH相对常见。在控制潜在混杂因素后，放置EVD与较低死亡率相关，但与更好的神经学结局无明显关联。此外，更快放置EVD与更高死亡率相关，这可能反映了脑疝或梗阻性脑积水的早期发展。
