Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：自发性脑出血（ICH）患者的预后常受到血肿量的影响，一个公认的不良结果预测指标。然而,预测不良结局的最佳脑室内出血(IVH)体积截止值仍未知.
方法：我们分析了313例未进行疏散的自发性ICH患者，其中脑室外引流(EVD)7例。这些患者接受了基线CT扫描，然后进行24小时CT扫描以测量血肿和IVH体积。我们将血肿生长定义为随访CT时血肿生长>33%或6mL，3个月时改良Rankin量表评分≥3分，结果较差。使用受试者工作曲线确定具有预测不良结果的最佳灵敏度和特异性的截止值。
结果：受试者工作特性分析确定6mL为预测不良结果的最佳截止值。在313例患者中的53例(16.9%)中观察到IVH体积>6mL。IVH体积>6mL的患者更可能年龄更大，NIHSS评分更高，GCS评分更低。在多变量回归分析中，IVH体积>6mL（校正OR2.43，95％CI1.13-5.30；P=0.026）被发现是3个月时不良临床结局的独立预测因素。
结论：最佳IVH体积截止值是改善ICH患者不良预后预测的有力工具，特别是在没有血块疏散或常见使用EVD的情况下。少量脑室内血液与脑出血患者的不良预后无关。最佳IVH体积截止值的利用可以通过靶向将从治疗中获得最大益处的ICH患者来改善临床试验设计。
方法：我们分析了313例未进行疏散的自发性ICH患者，其中脑室外引流(EVD)7例。这些患者接受了基线CT扫描，然后进行24小时CT扫描以测量血肿和IVH体积。我们将血肿生长定义为随访CT时血肿生长>33%或6mL，3个月时改良Rankin量表评分≥3分，结果较差。使用受试者工作曲线确定具有预测不良结果的最佳灵敏度和特异性的截止值。
结果：受试者工作特性分析确定6mL为预测不良结果的最佳截止值。在313例患者中的53例(16.9%)中观察到IVH体积>6mL。IVH体积>6mL的患者更可能年龄更大，NIHSS评分更高，GCS评分更低。在多变量回归分析中，IVH体积>6mL（校正OR2.43，95％CI1.13-5.30；P=0.026）被发现是3个月时不良临床结局的独立预测因素。
结论：最佳IVH体积截止值是改善ICH患者不良预后预测的有力工具，特别是在没有血块疏散或常见使用EVD的情况下。少量脑室内血液与脑出血患者的不良预后无关。最佳IVH体积截止值的利用可以通过靶向将从治疗中获得最大益处的ICH患者来改善临床试验设计。
