Feldstein Eric, Zhong Allison, Clare Kevin, Nolan Bridget, Patel Smit, Lavi-Romer Nir, Stadlan Zehavya, Dicpinigaitis Alis, Dominguez Jose, Kamal Haris, Shapiro Steven D, Biswas Arundhati, Tanweer Omar, Bulsara Ketan, Muh Carrie, Pisapia Jared, Hanft Simon, Mayer Stephan, Gandhi Chirag D, Al-Mufti Fawaz
Westchester Medical Center/New York Medical College, Valhalla, NY, USA.
Division of Neurosurgery, University of Connecticut, Farmington, CT, USA.
Interv Neuroradiol. 2025 Aug;31(4):489-495. doi: 10.1177/15910199231173458. Epub 2023 May 8.
BackgroundLimited literature exists on the morbidity and mortality of AVM associated intracerebral hemorrhage (ICH) compared with non-AVM ICH.ObjectiveWe examine morbidity and mortality in cAVM in a large nationwide inpatient sample to create a prognostic inpatient ruptured AVM mortality score.MethodsThis retrospective cohort study from 2008 to 2014 compares outcomes in cAVM related hemorrhages and ICH utilizing the National Inpatient Sample database. Diagnostic codes for ICH and AVM underlying ICH were identified. We compared case fatality according to medical complications. Multivariate analysis was used to derive hazard ratios and 95% confidence intervals to assess odds of mortality.ResultsWe identified 6496 patients with ruptured AVMs comparing them to 627,185 admitted with ICH. Mortality was lower for ruptured AVMs (11%) compared to ICH (22%) [ < 0.01]. Mortality associated factors were liver disease (OR 2.64, CI 1.81-3.85, < .001), diabetes mellitus (OR 2.42, CI 1.38-4.22, = 0.002), alcohol abuse (OR 1.81, CI 1.31-2.49, = 0.001), hydrocephalus (OR 3.35 CI 2.81-4.00, < 0.001), cerebral edema (OR 1.5, 1.25-1.85, < 0.001), cardiac arrest (OR 15, CI 7.9-30, < 0.001), and pneumonia (OR 1.93, CI 1.51-2.47, < 0.001). A 0-5 ruptured AVM mortality score was developed: Cardiac arrest (=3), age >60 (=1), Black race (=1), chronic liver failure (=1) diabetes mellitus (=1), pneumonia (=1), alcohol abuse (=1) and cerebral edema (=1). Mortality increased with score. No patient with 5 or more points survived.ConclusionThe Ruptured AVM Mortality Score allows for risk stratification on patients with ICH due to ruptured AVM. This scale could prove useful in prognostication and patient education.
与非动静脉畸形（AVM）相关的脑出血（ICH）相比，关于AVM相关脑出血的发病率和死亡率的文献有限。
我们在一个全国性的大型住院患者样本中研究脑动静脉畸形（cAVM）的发病率和死亡率，以创建一个住院患者破裂性AVM死亡率的预后评分。
这项2008年至2014年的回顾性队列研究利用国家住院患者样本数据库比较了cAVM相关出血和ICH的结局。确定了ICH和ICH潜在的AVM的诊断代码。我们根据医疗并发症比较了病死率。采用多变量分析得出风险比和95%置信区间，以评估死亡几率。
我们确定了6496例破裂性AVM患者，并将他们与627185例因ICH入院的患者进行比较。破裂性AVM的死亡率（11%）低于ICH（22%）[<0.01]。与死亡相关的因素有肝病（比值比2.64，置信区间1.81-3.85，<0.001）、糖尿病（比值比2.42，置信区间1.38-4.22，=0.002）、酒精滥用（比值比1.81，置信区间1.31-2.49，=0.001）、脑积水（比值比3.35，置信区间2.81-4.00，<0.001）、脑水肿（比值比1.5，1.25-1.85，<0.001）、心脏骤停（比值比15，置信区间7.9-30，<0.001）和肺炎（比值比1.93，置信区间1.51-2.47，<0.001）。制定了一个0至5分的破裂性AVM死亡率评分：心脏骤停（=3分）、年龄>60岁（=1分）、黑人种族（=1分）、慢性肝功能衰竭（=1分）、糖尿病（=1分）、肺炎（=1分）、酒精滥用（=1分）和脑水肿（=1分）。死亡率随评分增加。没有得分5分或更高的患者存活。
破裂性AVM死亡率评分可对因破裂性AVM导致ICH的患者进行风险分层。该量表在预后评估和患者教育中可能有用。
