Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Department of Neurology, Chengde Central Hospital, Chengde 067000, Hebei, China.
J Stroke Cerebrovasc Dis. 2024 Jun;33(6):107683. doi: 10.1016/j.jstrokecerebrovasdis.2024.107683. Epub 2024 Mar 19.
BACKGROUND AND OBJECTIVES: The prognosis of patients with spontaneous intracerebral hemorrhage (ICH) is often influenced by hematoma volume, a well-established predictor of poor outcome. However, the optimal intraventricular hemorrhage (IVH) volume cutoff for predicting poor outcome remains unknown. METHODS: We analyzed 313 patients with spontaneous ICH not undergoing evacuation, including 7 cases with external ventricular drainage (EVD). These patients underwent a baseline CT scan, followed by a 24-hour CT scan for measurement of both hematoma and IVH volume. We defined hematoma growth as hematoma growth > 33 % or 6 mL at follow-up CT, and poor outcome as modified Rankin Scale score≥3 at three months. Cutoffs with optimal sensitivity and specificity for predicting poor outcome were identified using receiver operating curves. RESULTS: The receiver operating characteristic analysis identified 6 mL as the optimal cutoff for predicting poor outcome. IVH volume> 6 mL was observed in 53 (16.9 %) of 313 patients. Patients with IVH volume>6 mL were more likely to be older and had higher NIHSS score and lower GCS score than those without. IVH volume>6 mL (adjusted OR 2.43, 95 % CI 1.13-5.30; P = 0.026) was found to be an independent predictor of poor clinical outcome at three months in multivariable regression analysis. CONCLUSIONS: Optimal IVH volume cutoff represents a powerful tool for improving the prediction of poor outcome in patients with ICH, particularly in the absence of clot evacuation or common use of EVD. Small amounts of intraventricular blood are not independently associated with poor outcome in patients with intracerebral hemorrhage. The utilization of optimal IVH volume cutoffs may improve the clinical trial design by targeting ICH patients that will obtain maximal benefit from therapies.
背景与目的：脑出血（ICH）患者的预后通常受血肿量的影响，血肿量是预后不良的一个公认的预测因素。然而，预测不良预后的最佳脑室内出血（IVH）量的截止值尚不清楚。
方法：我们分析了 313 例未行血肿清除术的自发性 ICH 患者，其中 7 例患者行脑室外引流术（EVD）。这些患者行基线 CT 扫描，然后在 24 小时内行 CT 扫描以测量血肿和 IVH 量。我们将血肿增长定义为随访 CT 时血肿增长>33%或 6 mL，改良 Rankin 量表评分≥3 定义为不良预后。采用受试者工作特征曲线确定预测不良预后的最佳灵敏度和特异性的截断值。
结果：受试者工作特征分析确定 6 mL 为预测不良预后的最佳截断值。313 例患者中，有 53 例（16.9%）IVH 量>6 mL。与 IVH 量<6 mL 的患者相比，IVH 量>6 mL 的患者年龄更大，NIHSS 评分更高，GCS 评分更低。多变量回归分析显示，IVH 量>6 mL（调整后的 OR 2.43，95%CI 1.13-5.30；P=0.026）是 3 个月时不良临床结局的独立预测因素。
结论：最佳 IVH 量截断值是提高 ICH 患者不良预后预测能力的有力工具，特别是在没有清除血肿或常规使用 EVD 的情况下。少量脑室内出血与脑出血患者的不良预后无独立相关性。最佳 IVH 量截断值的应用可能通过针对最有可能从治疗中获益的 ICH 患者，改善临床试验设计。
J Stroke Cerebrovasc Dis. 2024-6
Clin Neurol Neurosurg. 2020-2
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