Lehto Sami, Sajanti Antti, Hellström Santtu, Koskimäki Fredrika, Srinath Abhinav, Bennett Carolyn, Carrión-Penagos Julián, Cao Ying, Jänkälä Miro, Girard Romuald, Rinne Jaakko, Rahi Melissa, Koskimäki Janne
Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Finland.
Medical Research Center, Research Unit of Clinical Medicine, University of Oulu, Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
Brain Spine. 2024 Aug 6;4:102914. doi: 10.1016/j.bas.2024.102914. eCollection 2024.
Spontaneous intracerebral haemorrhage (sICH) is a major cause of morbidity and mortality. Large-scale trials have shown neutral outcomes for surgical interventions. The recent trial suggested functional benefits from surgical intervention. Surgical treatment for sICH is likely increasing.
To determine the incidence of sICH in Southwest Finland, standardized to the European population, and to identify the proportion of large sICH patients eligible for surgery based on previously published trial criteria. We also examined factors associated with outcomes, including the effects of anticoagulant and antithrombotic medications.
A retrospective clinical study identified 596 ICH cases treated at Turku University Hospital (2018-2019), of which 286 were supratentorial sICHs. Variables were analysed using a -test, chi-squared or Fisher's exact test. A multivariate logistic modelling was performed to evaluate outcome differences.
The sICH incidence was 29.9/100,000 persons per year, with the highest European population age and sex standardized rates in individuals over 80 years old (110/100,000 males, 142/100,000 females). The incidence of sICH patients meeting surgical criteria was 2.7/100,000 persons per year. Out of 286 patients, 26 were eligible for surgery and had unfavourable outcomes (p = 0.0049). Multivariate analysis indicated a significant decrease in favourable outcomes with warfarin (p = 0.016, OR 0.42) and direct-acting anticoagulants (DOACs) (p = 0.034, OR 0.38), while antithrombotic medications showed no significant effect.
We identified comparable incidence of sICH as European average. A small proportion of sICH cases were identified to be candidates for surgical intervention. Anticoagulants were associated with increased risk of unfavourable outcomes.
自发性脑出血（sICH）是发病和死亡的主要原因。大规模试验显示手术干预的结果呈中性。最近的试验表明手术干预具有功能益处。sICH的手术治疗可能正在增加。
确定芬兰西南部sICH的发病率，并根据先前发表的试验标准将其标准化为欧洲人群发病率，同时确定符合手术条件的大型sICH患者的比例。我们还研究了与预后相关的因素，包括抗凝和抗血栓药物的影响。
一项回顾性临床研究确定了图尔库大学医院（2018 - 2019年）治疗的596例脑出血病例，其中286例为幕上sICH。使用t检验、卡方检验或Fisher精确检验分析变量。进行多变量逻辑建模以评估预后差异。
sICH发病率为每年29.9/10万人口，80岁以上个体的欧洲人群年龄和性别标准化发病率最高（男性110/10万，女性142/10万）。符合手术标准的sICH患者发病率为每年2.7/10万人口。在286例患者中，26例符合手术条件但预后不佳（p = 0.0049）。多变量分析表明，华法林（p = 0.016，OR 0.42）和直接作用抗凝剂（DOACs）（p = 0.034，OR 0.38）使良好预后显著降低，而抗血栓药物未显示出显著影响。
我们确定sICH发病率与欧洲平均水平相当。一小部分sICH病例被确定为手术干预的候选者。抗凝剂与不良预后风险增加相关。
