Department of Neurology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China.
Department of Pediatrics, Huangshi Maternity and Children's Health Hospital, Affiliated Maternity and Children's Health Hospital of Hubei Polytechnic University, Huangshi, China.
Neurocrit Care. 2024 Oct;41(2):541-549. doi: 10.1007/s12028-024-01963-x. Epub 2024 Mar 20.
Frequency of imaging markers (FIM) has been identified as an independent predictor of hematoma expansion in patients with intracerebral hemorrhage (ICH), but its impact on clinical outcome of ICH is yet to be determined. The aim of the present study was to investigate this association.
This study was a secondary analysis of our prior research. The data for this study were derived from six retrospective cohorts of ICH from January 2018 to August 2022. All consecutive study participants were examined within 6 h of stroke onset on neuroimaging. FIM was defined as the ratio of the number of imaging markers on noncontrast head tomography (i.e., hypodensities, blend sign, and island sign) to onset-to-neuroimaging time. The primary poor outcome was defined as a modified Rankin Scale score of 3-6 at 3 months.
A total of 1253 patients with ICH were included for final analysis. Among those with available follow-up results, 713 (56.90%) exhibited a poor neurologic outcome at 3 months. In a univariate analysis, FIM was associated with poor prognosis (odds ratio 4.36; 95% confidence interval 3.31-5.74; p < 0.001). After adjustment for age, Glasgow Coma Scale score, systolic blood pressure, hematoma volume, and intraventricular hemorrhage, FIM was still an independent predictor of worse prognosis (odds ratio 3.26; 95% confidence interval 2.37-4.48; p < 0.001). Based on receiver operating characteristic curve analysis, a cutoff value of 0.28 for FIM was associated with 0.69 sensitivity, 0.66 specificity, 0.73 positive predictive value, 0.62 negative predictive value, and 0.71 area under the curve for the diagnosis of poor outcome.
The metric of FIM is associated with 3-month poor outcome after ICH. The novel indicator that helps identify patients who are likely within the 6-h time window at risk for worse outcome would be a valuable addition to the clinical management of ICH.
影像学标志物（FIM）的频率已被确定为颅内出血（ICH）患者血肿扩大的独立预测因子，但它对 ICH 临床结果的影响尚未确定。本研究的目的是探讨这种相关性。
本研究是我们先前研究的二次分析。本研究的数据来自 2018 年 1 月至 2022 年 8 月的六个 ICH 回顾性队列。所有连续的研究参与者都在中风发作后 6 小时内进行神经影像学检查。FIM 定义为非对比头部 CT 上影像学标志物的数量与发病至神经影像学时间的比值（即，密度降低、混合征和岛征）。主要不良结局定义为 3 个月时改良 Rankin 量表评分为 3-6 分。
共纳入 1253 例 ICH 患者进行最终分析。在有随访结果的患者中，713 例（56.90%）在 3 个月时神经预后不良。在单因素分析中，FIM 与不良预后相关（优势比 4.36；95%置信区间 3.31-5.74；p<0.001）。在校正年龄、格拉斯哥昏迷量表评分、收缩压、血肿体积和脑室内出血后，FIM 仍然是预后不良的独立预测因子（优势比 3.26；95%置信区间 2.37-4.48；p<0.001）。基于受试者工作特征曲线分析，FIM 的截断值为 0.28 时，对预后不良的诊断具有 0.69 的敏感性、0.66 的特异性、0.73 的阳性预测值、0.62 的阴性预测值和 0.71 的曲线下面积。
FIM 与 ICH 后 3 个月的不良结局相关。这种新的指标有助于确定在 6 小时时间窗内处于不良结局风险中的患者，这将是 ICH 临床管理的一个有价值的补充。
