Abstract：
Factors associated with external ventricular catheter tract hemorrhage (CTH) are well studied; whether CTH adversely influence outcomes after intracerebral hemorrhage (sICH), however, is poorly understood. We therefore sought to evaluate the association between CTH and sICH outcomes.
We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses.
Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis.
Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.
We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses.
Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis.
Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.
摘要：
目的：与脑室导管外出血（CTH）相关的因素已被充分研究；CTH是否对脑出血（sICH）后的预后产生不利影响，然而,知之甚少。因此，我们试图评估CTH和sICH结果之间的关联。
方法：我们对凝块溶解：评估脑室内出血加速消退试验进行了事后分析。暴露于CTH，并在入院和随机化之间（约72小时）的连续计算机断层扫描中进行评估。主要结局是死亡或严重残疾（改良Rankin评分>3）和单独死亡率的复合。均在6个月时评估。次要结果是30天的功能结果，永久性脑脊液（CSF）分流术，任何感染,和脑室炎.我们进行了调整人口统计学的逻辑回归，合并症,sICH特性，和治疗分配，对于所有的分析。
结果：在500名患者中，平均年龄为59岁(SD，±11）岁和222（44％）为女性。CTH发生在112例（22.4%）患者中，在少数患者中更为常见，那些之前接受抗血小板治疗的人，和放置超过1个外部心室引流的患者。CTH患者治疗结束时脑室内出血量较高（11.7对7.9mL，P=.01)，但其他sICH特征或心室外引流的总持续时间没有差异.在多变量回归模型中，CTH与死亡或严重残疾无关(比值比，0.7；95%CI：0.4-1.2)或单独死亡(比值比，0.8；95%CI，0.5-1.4）。CTH与次要结局（包括30天功能结局）之间没有关系，永久性CSF分流安置,任何感染,或脑室炎。
结论：在sICH和大量脑室内出血的患者中，CTH与不良sICH结局无关，永久性CSF分流安置,或感染。需要更详细的认知评估来告知CTH在sICH预后中的作用。
方法：我们对凝块溶解：评估脑室内出血加速消退试验进行了事后分析。暴露于CTH，并在入院和随机化之间（约72小时）的连续计算机断层扫描中进行评估。主要结局是死亡或严重残疾（改良Rankin评分>3）和单独死亡率的复合。均在6个月时评估。次要结果是30天的功能结果，永久性脑脊液（CSF）分流术，任何感染,和脑室炎.我们进行了调整人口统计学的逻辑回归，合并症,sICH特性，和治疗分配，对于所有的分析。
结果：在500名患者中，平均年龄为59岁(SD，±11）岁和222（44％）为女性。CTH发生在112例（22.4%）患者中，在少数患者中更为常见，那些之前接受抗血小板治疗的人，和放置超过1个外部心室引流的患者。CTH患者治疗结束时脑室内出血量较高（11.7对7.9mL，P=.01)，但其他sICH特征或心室外引流的总持续时间没有差异.在多变量回归模型中，CTH与死亡或严重残疾无关(比值比，0.7；95%CI：0.4-1.2)或单独死亡(比值比，0.8；95%CI，0.5-1.4）。CTH与次要结局（包括30天功能结局）之间没有关系，永久性CSF分流安置,任何感染,或脑室炎。
结论：在sICH和大量脑室内出血的患者中，CTH与不良sICH结局无关，永久性CSF分流安置,或感染。需要更详细的认知评估来告知CTH在sICH预后中的作用。
