Zhongguo cuzhong zazhi (Feb 2023)
不同评分系统及血肿生长速度对脑出血患者短期死亡风险的预测价值研究 The Predictive Value of Different Intracerebral Hemorrhage Scores and Ultraearly Hematoma Growth for 30-day Mortality in Patients with Intracerebral Hemorrhage
Abstract
目的 探讨原始脑出血评分（original intracerebral hemorrhage scale，OICH）、脑出血分级量表（ICH-grading scale，ICH-GS）、脑出血功能结局量表（ICH functional outcome score，ICH-FOS）、改良急诊脑出血评分量表（modified emergency department intracerebral scale，MEDICH）及超早期血肿生长速度（ultraearly hematoma growth，uHG）对脑出血患者短期死亡风险的预测价值。 方法 收集2014年1月—2016年9月脑出血登记研究中急性脑出血患者的一般临床资料、既往病史、入院后首次实验室检查结果、血压、脑出血部位、血肿体积、住院期间并发症情况。对患者进行发病30 d随访，根据全因死亡情况，将患者分为死亡组和存活组，比较两组间基线资料、uHG（基线血肿体积/发病到基线CT的时间）和不同脑出血评分。通过单因素logistic回归分析判断不同脑出血评分对患者30 d生存结局的影响，进一步通过生存曲线的AUC比较不同评分及联合uHG对30 d死亡的预测效能。 结果 研究共纳入脑出血患者1664例，30 d随访死亡308例，存活1356例。单因素logistic回归分析显示，死亡组的OICH、ICH-GS、ICH-FOS、MEDICH各项得分及uHG均高于存活组，差异具有统计学意义。根据出血部位、性别、年龄、出血量进行亚组分析，除幕下出血组外，其余亚组的uHG与30 d死亡均相关（均P<0.05）。计算AUC发现，ICH-FOS对患者短期死亡结局的预测价值最高，AUC=0.8599。分析uHG联合ICH-FOS的预测价值，发现对患者结局预测价值较单独ICH-FOS的效能更高（按照uHG是否大于本研究中均值分别赋值0和1，与ICH-FOS其他指标联合构成脑出血功能结局量表-血肿生长速度评分1，AUC=8604；按照uHG四分位数区间分别赋值0、1、2、3，与ICH-FOS其他指标联合构成脑出血功能结局量表-血肿生长速度评分2，AUC=0.8652）。 结论 不同的常见脑出血预后评分与急性脑出血患者短期生存结局均明显相关且均有较好的预测效能。uHG联合ICH-FOS评分对脑出血患者短期生存结局较单独ICH-FOS评分具有更高的预测价值。 Abstract: Objective To investigate the predictive value of original intracerebral hemorrhage scale (OICH), intracerebral hemorrhage-grading scale (ICH-GS), intracerebral hemorrhage functional outcome score (ICH-FOS), modified emergency department intracerebral scale (MEDICH) and ultraearly hematoma growth (uHG) for 30-day mortality in patients with intracerebral hemorrhage (ICH). Methods This study enrolled the consecutive ICH patients from the ICH Registry Study from January 2014 to September 2016. The collected data included the baseline information, physical examination, laboratory examinations, ICH location and volume, complications during the hospital stay, and 30-day follow-up. The patients were divided into survival group and death group according to the 30-day follow-up after ICH onset. Logistic regression analysis was used to analyze the effect of different ICH scores on 30-day outcome. The area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of ICH scores alone, and ICH score combined with uHG for 30-day ICH outcome. Results A total of 1 664 ICH patients were finally included in this study. There were 308 deaths and 1 356 survivals at 30-day follow-up. Logistic regression analysis showed that the scores of OICH, ICH- GS, ICH-FOS and MEDICH scores and uHG in death group were all higher than that in survival group, with statistical differences. Analyzing the effect of uHG on 30-day mortality in different subgroups, the results showed that uHG were all correlated with the 30-day mortality in different ICH volume, sex and age subgroups, while in ICH location subgroup, uHG was correlated with the 30-day mortality only in supratentorial ICH, and they were not correlated in subtentorial ICH (all P<0.05). The AUC of ICH-FOS prediction for 30-day outcome was the largest among all scores (AUC=0.8599). Compared to the ICH-FOS alone, ICH-FOS combined with uHG had a higher predictive value for 30-day outcome. Conclusion The commonly used ICH scores all had a good predictive value for 30-day outcome in ICH patients. ICH-FOS score combined with uHG had a higher predictive value for 30-day ICH outcome than the ICH-FOS alone.
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