自发性小脑出血患者的长期预后：一项国际队列研究
Long-Term Outcomes in Patients With Spontaneous Cerebellar Hemorrhage: An International Cohort Study.
作者信息
Senff Jasper R, Singh Sanjula D, Pasi Marco, Jolink Wilmar M T, Rodrigues Mark A, Schreuder Floris H B M, Staals Julie, Schreuder Tobien, Douwes Jules P J, Talsma Jelmer, McKaig Brenna N, Kourkoulis Christina, Yechoor Nirupama, Anderson Christopher D, Puy Laurent, Cordonnier Charlotte, Wermer Marieke J H, Rothwell Peter M, Rosand Jonathan, Klijn Catharina J M, Al-Shahi Salman Rustam, Rinkel Gabriël J E, Viswanathan Anand, Goldstein Joshua N, Brouwers H Bart
机构信息
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.).
Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.).
出版信息
Stroke. 2024 May;55(5):1210-1217. doi: 10.1161/STROKEAHA.123.044622. Epub 2024 Mar 15.
BACKGROUND
Spontaneous intracerebral hemorrhage (ICH) in the cerebellum has a poor short-term prognosis, whereas data on the long-term case fatality and recurrent vascular events are sparse. Herewith, we aimed to assess the long-term case fatality and recurrence rate of vascular events after a first cerebellar ICH.
METHODS
In this international cohort study, we included patients from 10 hospitals (the United States and Europe from 1997 to 2017) aged ≥18 years with a first spontaneous cerebellar ICH who were discharged alive. Data on long-term case fatality and recurrence of vascular events (recurrent ICH [supratentoria or infratentorial], ischemic stroke, myocardial infarction, or major vascular surgery) were collected for survival analysis and absolute event rate calculation.
RESULTS
We included 405 patients with cerebellar ICH (mean age [SD], 72 [13] years, 49% female). The median survival time was 67 months (interquartile range, 23-100 months), with a cumulative survival rate of 34% at 10-year follow-up (median follow-up time per center ranged: 15-80 months). In the 347 patients with data on vascular events 92 events occurred in 78 patients, after initial cerebellar ICH: 31 (8.9%) patients had a recurrent ICH (absolute event rate, 1.8 per 100 patient-years [95% CI, 1.2-2.6]), 39 (11%) had an ischemic stroke (absolute event rate, 2.3 [95% CI, 1.6-3.2]), 13 (3.7%) had a myocardial infarction (absolute event rate, 0.8 [95% CI, 0.4-1.3]), and 5 (1.4%) underwent major vascular surgery (absolute event rate, 0.3 [95% CI, 0.1-0.7]). The median time to a first vascular event during follow-up was 27 months (interquartile range, 8.7-50 months), with a cumulative hazard of 47% at 10 years.
CONCLUSIONS
The long-term prognosis of patients who survive a first spontaneous cerebellar ICH is poor and comparable to that of patients who survive a first supratentorial ICH. Further identification of patients at high risk of vascular events following the initial cerebellar ICH is needed. Including patients with cerebellar ICH in randomized controlled trials on secondary prevention of patients with ICH is warranted.
背景
小脑自发性脑出血（ICH）的短期预后较差，而关于长期病死率和复发性血管事件的数据较少。在此，我们旨在评估首次小脑ICH后的长期病死率和血管事件复发率。
方法
在这项国际队列研究中，我们纳入了1997年至2017年期间来自10家医院（美国和欧洲）的年龄≥18岁且首次自发性小脑ICH后存活出院的患者。收集关于长期病死率和血管事件复发（复发性ICH[幕上或幕下]、缺血性卒中、心肌梗死或大血管手术）的数据用于生存分析和绝对事件率计算。
结果
我们纳入了405例小脑ICH患者（平均年龄[标准差]，72[13]岁，49%为女性）。中位生存时间为67个月（四分位间距，23 - 100个月），10年随访时累积生存率为34%（每个中心的中位随访时间范围为：15 - 80个月）。在347例有血管事件数据的患者中，首次小脑ICH后78例患者发生了92次事件：31例（8.9%）患者发生复发性ICH（绝对事件率，每100患者年1.8次[95%CI，1.2 - 2.6]），39例（11%）发生缺血性卒中（绝对事件率，2.3[95%CI，1.6 - 3.2]），13例（3.7%）发生心肌梗死（绝对事件率，0.8[95%CI，0.4 - 1.3]），5例（1.4%）接受了大血管手术（绝对事件率，0.3[95%CI，0.1 - 0.7]）。随访期间首次血管事件的中位时间为27个月（四分位间距，8.7 - 50个月），10年时累积风险为47%。
结论
首次自发性小脑ICH存活患者的长期预后较差，与首次幕上ICH存活患者相当。需要进一步识别首次小脑ICH后血管事件高风险患者。将小脑ICH患者纳入ICH患者二级预防的随机对照试验是有必要的。
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