Abstract：
BACKGROUND: Life-threatening, space-occupying mass effect due to cerebral edema and/or hemorrhagic transformation is an early complication of patients with middle cerebral artery stroke. Little is known about longitudinal trajectories of laboratory and vital signs leading up to radiographic and clinical deterioration related to this mass effect.
METHODS: We curated a retrospective data set of 635 patients with large middle cerebral artery stroke totaling 95,463 data points for 10 longitudinal covariates and 40 time-independent covariates. We assessed trajectories of the 10 longitudinal variables during the 72 h preceding three outcomes representative of life-threatening mass effect: midline shift ≥ 5 mm, pineal gland shift (PGS) > 4 mm, and decompressive hemicraniectomy (DHC). We used a \"backward-looking\" trajectory approach. Patients were aligned based on outcome occurrence time and the trajectory of each variable was assessed before that outcome by accounting for cases and noncases, adjusting for confounders. We evaluated longitudinal trajectories with Cox proportional time-dependent regression.
RESULTS: Of 635 patients, 49.0% were female, and the mean age was 69 years. Thirty five percent of patients had midline shift ≥ 5 mm, 24.3% of patients had PGS > 4 mm, and 10.7% of patients underwent DHC. Backward-looking trajectories showed mild increases in white blood cell count (10-11 K/UL within 72 h), temperature (up to half a degree within 24 h), and sodium levels (1-3 mEq/L within 24 h) before the three outcomes of interest. We also observed a decrease in heart rate (75-65 beats per minute) 24 h before DHC. We found a significant association between increased white blood cell count with PGS > 4 mm (hazard ratio 1.05, p value 0.007).
CONCLUSIONS: Longitudinal profiling adjusted for confounders demonstrated that white blood cell count, temperature, and sodium levels appear to increase before radiographic and clinical indicators of space-occupying mass effect. These findings will inform the development of multivariable dynamic risk models to aid prediction of life-threatening, space-occupying mass effect.
METHODS: We curated a retrospective data set of 635 patients with large middle cerebral artery stroke totaling 95,463 data points for 10 longitudinal covariates and 40 time-independent covariates. We assessed trajectories of the 10 longitudinal variables during the 72 h preceding three outcomes representative of life-threatening mass effect: midline shift ≥ 5 mm, pineal gland shift (PGS) > 4 mm, and decompressive hemicraniectomy (DHC). We used a \"backward-looking\" trajectory approach. Patients were aligned based on outcome occurrence time and the trajectory of each variable was assessed before that outcome by accounting for cases and noncases, adjusting for confounders. We evaluated longitudinal trajectories with Cox proportional time-dependent regression.
RESULTS: Of 635 patients, 49.0% were female, and the mean age was 69 years. Thirty five percent of patients had midline shift ≥ 5 mm, 24.3% of patients had PGS > 4 mm, and 10.7% of patients underwent DHC. Backward-looking trajectories showed mild increases in white blood cell count (10-11 K/UL within 72 h), temperature (up to half a degree within 24 h), and sodium levels (1-3 mEq/L within 24 h) before the three outcomes of interest. We also observed a decrease in heart rate (75-65 beats per minute) 24 h before DHC. We found a significant association between increased white blood cell count with PGS > 4 mm (hazard ratio 1.05, p value 0.007).
CONCLUSIONS: Longitudinal profiling adjusted for confounders demonstrated that white blood cell count, temperature, and sodium levels appear to increase before radiographic and clinical indicators of space-occupying mass effect. These findings will inform the development of multivariable dynamic risk models to aid prediction of life-threatening, space-occupying mass effect.
摘要：
背景：危及生命，脑水肿和/或出血性转化引起的占位效应是大脑中动脉卒中患者的早期并发症。对于导致与这种质量效应相关的影像学和临床恶化的实验室和生命体征的纵向轨迹知之甚少。
方法：我们收集了635例大脑中动脉大卒中患者的回顾性数据集，共95,463个数据点，10个纵向协变量和40个时间无关协变量。我们评估了前72小时内10个纵向变量的轨迹，这三个结果代表了危及生命的质量效应：中线偏移≥5mm，松果体移位(PGS)>4mm,和去骨瓣减压术（DHC）。我们使用了“向后看”轨迹方法。患者根据结果发生时间进行排列，并在该结果之前通过考虑病例和非病例来评估每个变量的轨迹。适应混杂因素。我们用Cox比例时间依赖性回归评估纵向轨迹。
结果：在635名患者中，49.0％为女性，平均年龄是69岁.35%的患者中线移位≥5mm，24.3%的患者PGS>4mm,10.7%的患者接受了DHC。向后看的轨迹显示白细胞计数轻度增加（72小时内10-11K/UL），温度（24小时内达到半度），和钠水平（24小时内1-3mEq/L）在三个感兴趣的结果之前。我们还观察到DHC前24小时心率下降（每分钟75-65次）。我们发现白细胞计数增加与PGS>4mm之间存在显著关联(风险比1.05,p值0.007)。
结论：对混杂因素进行调整的纵向分析表明，白细胞计数，温度,和钠水平似乎在X线摄影和临床指标占位性肿块效应之前增加。这些发现将为多变量动态风险模型的发展提供信息，以帮助预测危及生命的风险。占据空间的质量效应。
方法：我们收集了635例大脑中动脉大卒中患者的回顾性数据集，共95,463个数据点，10个纵向协变量和40个时间无关协变量。我们评估了前72小时内10个纵向变量的轨迹，这三个结果代表了危及生命的质量效应：中线偏移≥5mm，松果体移位(PGS)>4mm,和去骨瓣减压术（DHC）。我们使用了“向后看”轨迹方法。患者根据结果发生时间进行排列，并在该结果之前通过考虑病例和非病例来评估每个变量的轨迹。适应混杂因素。我们用Cox比例时间依赖性回归评估纵向轨迹。
结果：在635名患者中，49.0％为女性，平均年龄是69岁.35%的患者中线移位≥5mm，24.3%的患者PGS>4mm,10.7%的患者接受了DHC。向后看的轨迹显示白细胞计数轻度增加（72小时内10-11K/UL），温度（24小时内达到半度），和钠水平（24小时内1-3mEq/L）在三个感兴趣的结果之前。我们还观察到DHC前24小时心率下降（每分钟75-65次）。我们发现白细胞计数增加与PGS>4mm之间存在显著关联(风险比1.05,p值0.007)。
结论：对混杂因素进行调整的纵向分析表明，白细胞计数，温度,和钠水平似乎在X线摄影和临床指标占位性肿块效应之前增加。这些发现将为多变量动态风险模型的发展提供信息，以帮助预测危及生命的风险。占据空间的质量效应。
