Cappellari Manuel, Zenorini Mara, Bonetti Bruno
Neurology and Stroke Unit, DAI di Neuroscienze Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
Neurol Sci. 2025 May 23. doi: 10.1007/s10072-025-08238-z.
Bundle care has recently been the topic of expert consensus statements for optimal management of ICH. The aim of the present study was to assess the application of each intervention of these bundles of care and their combination in the real world and their effect on functional outcome and hematoma expansion.
We analyzed data from 273 patients with spontaneous ICH who were consecutively admitted to AOUI Verona between January 2022 and June 2024. The components of the bundle of care were the following: (A) door-to-reversal agent administration ≤ 60 min, (B) systolic blood pressure (SBP) target (≤ 140 mmHg), (C) blood glucose (BG) target (108-140 mg/dL in non-diabetic patients and 140-180 mg/dL in diabetic patients), and 4) body temperature (BT) target (≤ 37,5 °C) ≤ 60 min. The primary endpoint was 3-month mRS 0-2. Secondary endpoints were the following: (a) 3-month mortality, (b) 24-hour severe hematoma expansion, (c) 3-month mRS 0-2 in survivors.
BP target (≤ 140 mmHg) ≤ 60 min was associated with higher rate of mRS 0-2 (aOR:4.795; 95% CI:1.343-17.120; p = 0.016) (third model of adjustment for unbalanced variables), lower rate of severe hematoma expansion (aOR:0.254, 95% CI:0.070-0.928; p = 0.038) and higher rate of mRS 0-2 in survivors (aOR:4.445; 95% CI:1.358-13.548; p = 0.014), and BG target ≤ 60 min was associated with lower rate of mortality (aOR:0.290, 95% CI:0.088-0.948; p = 0.041) (adjustment for pre-defined variables).
Early intensive SBP control is the most effective intervention of the bundle of care for improving functional outcomes and reducing hematoma expansion. Early intensive BG control is effective in reducing mortality.
集束化治疗最近已成为脑出血最佳管理专家共识声明的主题。本研究的目的是评估这些集束化治疗的每种干预措施及其组合在现实世界中的应用情况，以及它们对功能结局和血肿扩大的影响。
我们分析了2022年1月至2024年6月期间连续入住维罗纳AOUI的273例自发性脑出血患者的数据。集束化治疗的组成部分如下：（A）从入院到给予逆转剂的时间≤60分钟，（B）收缩压（SBP）目标值（≤140 mmHg），（C）血糖（BG）目标值（非糖尿病患者为108 - 140 mg/dL，糖尿病患者为140 - 180 mg/dL），以及（D）体温（BT）目标值（≤37.5°C）≤60分钟。主要终点是3个月改良Rankin量表（mRS）评分为0 - 2分。次要终点如下：（a）3个月死亡率，（b）24小时严重血肿扩大，（c）幸存者3个月mRS评分为0 - 2分。
SBP目标值（≤140 mmHg）≤60分钟与mRS 0 - 2分的较高发生率相关（调整不平衡变量的第三个模型：调整后比值比[aOR]：4.795；95%置信区间[CI]：1.343 - 17.120；p = 0.016），严重血肿扩大的发生率较低（aOR：0.254，95% CI：0.070 - 0.928；p = 0.038），幸存者中mRS 0 - 2分的发生率较高（aOR：4.445；95% CI：1.358 - 13.548；p = 0.014），并且BG目标值≤60分钟与较低的死亡率相关（aOR：0.290，95% CI：0.088 - 0.948；p = 0.041）（对预定义变量进行调整）。
早期强化SBP控制是集束化治疗中改善功能结局和减少血肿扩大最有效的干预措施。早期强化BG控制可有效降低死亡率。
