Department of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China.
Computer School, Hubei Polytechnic University, Huangshi, China.
Int J Stroke. 2024 Feb;19(2):226-234. doi: 10.1177/17474930231205221. Epub 2023 Oct 12.
Hematoma expansion (HE) is common in patients with intracerebral hemorrhage (ICH) and associated with a worse outcome. Imaging makers and shorter time from symptom onset are both associated with HE, but prognostic scores based on these parameters individually have not been satisfactory. We hypothesized that a score including both imaging markers of expansion, and time of onset, would improve prediction.
Patients with supratentorial ICH within 6 h after onset were consecutively recruited from six centers between January 2018 and August 2022. Three markers were used: hypodensities, the blend sign, and the island sign. We first defined frequency of imaging markers (FIM) as the relationship between the number of imaging markers and onset-to-CT time (OCT). The time-adjusted FIM was defined as the ratio of the number of imaging markers to the onset-to-initial imaging time. Multivariate analysis was performed to determine the relationship between FIM and HE. Receiver operating curve analysis was used to identify potential threshold values of FIM that optimally predict HE. In addition, the sensitivity, specificity, positive and negative predictive values (PPVs and NPVs), and the area under the curve (AUC) of the optimal cut-off in predicting HE were calculated.
In total, 1488 patients were eligible for inclusion, of whom 418 had incident HE. Multivariate analysis showed that age, male sex, baseline Glasgow Coma Scale score, presence of intraventricular hemorrhage, and FIM were independent predictors of HE (odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.97-0.99; OR = 1.73, 95% CI = 1.28-2.35; OR = 0.87, 95% CI = 0.83-0.92; OR = 0.42, 95% CI = 0.28-0.62; OR = 7.82, 95% CI = 5.86-10.42, respectively). The optimal cut-off point for FIM in predicting HE was 0.63, with sensitivity, specificity, PPV, NPV, and AUC values of 0.69, 0.89, 0.71, 0.88, and 0.83, respectively.
The FIM adjusted for time since symptom onset is a significant predictor of HE. Its use may allow improved prediction of those patients with ICH who develop HE, and the score may be clinically applicable in the management of patients with ICH.
血肿扩大（HE）在脑出血（ICH）患者中很常见，与预后不良有关。影像学标志物和症状发作后的时间都与 HE 有关，但基于这些参数的预后评分并不令人满意。我们假设，包括扩大的影像学标志物和发病时间在内的评分将改善预测。
在发病后 6 小时内，从 2018 年 1 月至 2022 年 8 月，从六个中心连续招募幕上 ICH 患者。使用了三种标志物：低信号区、混合征和岛征。我们首先将影像学标志物的频率（FIM）定义为影像学标志物数量与发病至 CT 时间（OCT）的关系。时间调整的 FIM 定义为影像学标志物数量与发病至初始影像学时间的比值。进行多变量分析以确定 FIM 与 HE 之间的关系。通过接受者操作特征曲线分析确定 FIM 预测 HE 的潜在最佳阈值。此外，计算最佳截断值预测 HE 的灵敏度、特异性、阳性和阴性预测值（PPV 和 NPV）以及曲线下面积（AUC）。
共纳入 1488 例符合条件的患者，其中 418 例发生了 HE。多变量分析表明，年龄、男性、基线格拉斯哥昏迷量表评分、存在脑室内出血和 FIM 是 HE 的独立预测因素（比值比（OR）=0.98，95%置信区间（CI）=0.97-0.99；OR=1.73，95%CI=1.28-2.35；OR=0.87，95%CI=0.83-0.92；OR=0.42，95%CI=0.28-0.62；OR=7.82，95%CI=5.86-10.42，分别）。FIM 预测 HE 的最佳截断点为 0.63，其灵敏度、特异性、PPV、NPV 和 AUC 值分别为 0.69、0.89、0.71、0.88 和 0.83。
时间调整后的 FIM 是 HE 的重要预测因素。它的使用可能可以更好地预测那些发生 HE 的 ICH 患者，并且该评分可能在 ICH 患者的管理中具有临床应用价值。
