Menglu Ouyang, Shoujiang You, Tom J Moullaali, Candice Delcourt, Else Charlotte Sandset, Lisa Woodhouse, Zhe Kang Law, Hisatomi Arima, Ken Butcher, Leon Stephen Edwards, Salil Gupta, Wen Jiang, Sebastian Koch, John Potter, Adnan I Qureshi, Thompson G Robinson, Rustam Al-Shahi Salman, Jeffrey L Saver, Nikola Sprigg, Joanna Wardlaw, Craig S Anderson, Philip M Bath, John Philip Chalmers, Xia Wang
{"title":"脑出血后血肿生长和功能恢复的轨迹：BASC数据的潜在分类分析。","authors":"Menglu Ouyang, Shoujiang You, Tom J Moullaali, Candice Delcourt, Else Charlotte Sandset, Lisa Woodhouse, Zhe Kang Law, Hisatomi Arima, Ken Butcher, Leon Stephen Edwards, Salil Gupta, Wen Jiang, Sebastian Koch, John Potter, Adnan I Qureshi, Thompson G Robinson, Rustam Al-Shahi Salman, Jeffrey L Saver, Nikola Sprigg, Joanna Wardlaw, Craig S Anderson, Philip M Bath, John Philip Chalmers, Xia Wang","doi":"10.1159/000547678","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Moderate blood pressure (BP) reduction reduces hematoma growth, but this has not been shown to translate into improved functional recovery after intracerebral hemorrhage (ICH). This study aimed to define patient profiles according to hematoma growth and functional recovery patterns, and explore the prognostic factors of the patterns.</p><p><strong>Methods: </strong>Analysis of the Blood Pressure in Acute Stroke Collaboration (BASC) dataset involved randomized controlled trials of early BP lowering in acute ICH. Latent class analysis was used to identify patient profiles by hematoma volume change from baseline to 24 h on outcome trajectories. Clinical outcomes include functional outcomes measured according to modified Rankin Scale (mRS) and serious adverse events at follow-up (usually 90 days). Generalized linear mixed models were used with adjustment of source trial as a random effect for clustering to identify the prognostic factors.</p><p><strong>Results: </strong>Among 6,221 participants from BASC, 2,450 patients (mean age 64.1 + 13.1 years, female 36.7%) were included. Baseline hematoma volumes (mL) were 6.8, 13.2, 27.1, and 59.2, respectively, for each class identified by patient profiles: no growth with favorable outcome (52.1%, median growth 0.2 [IQR -0.4 to 1.1] mL, median mRS 2 [IQR 1 to 2]), mild growth with disability (32.6%, 0.8 [-0.8 to 4.6] mL, mRS 4 [4 to 5]), moderate growth with death or disability (13.2%, 11.2 [4.9 to 27.0] mL, mRS 4 [3 to 6]), and large growth with death (2.1%, 35.2 [12.8 to 81.2] mL, mRS 6 [6 to 6]). Patients with moderate growth were younger and more likely to undergo neurosurgery than those in the mild or large growth groups. Baseline hematoma volume was the only significant factor associated with all the hematoma pattern groups.</p><p><strong>Conclusions: </strong>Patients with moderate growth were younger and more likely to receive neurosurgery than those in the mild or large growth groups. Baseline hematoma volume is the most important factor for hematoma growth and clinical outcome.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":1.5000,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Trajectory of Hematoma Growth and Functional Recovery after Intracerebral Hemorrhage: A Latent Class Analysis of Blood Pressure in Acute Stroke Collaboration Data.\",\"authors\":\"Menglu Ouyang, Shoujiang You, Tom J Moullaali, Candice Delcourt, Else Charlotte Sandset, Lisa Woodhouse, Zhe Kang Law, Hisatomi Arima, Ken Butcher, Leon Stephen Edwards, Salil Gupta, Wen Jiang, Sebastian Koch, John Potter, Adnan I Qureshi, Thompson G Robinson, Rustam Al-Shahi Salman, Jeffrey L Saver, Nikola Sprigg, Joanna Wardlaw, Craig S Anderson, Philip M Bath, John Philip Chalmers, Xia Wang\",\"doi\":\"10.1159/000547678\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Moderate blood pressure (BP) reduction reduces hematoma growth, but this has not been shown to translate into improved functional recovery after intracerebral hemorrhage (ICH). This study aimed to define patient profiles according to hematoma growth and functional recovery patterns, and explore the prognostic factors of the patterns.</p><p><strong>Methods: </strong>Analysis of the Blood Pressure in Acute Stroke Collaboration (BASC) dataset involved randomized controlled trials of early BP lowering in acute ICH. Latent class analysis was used to identify patient profiles by hematoma volume change from baseline to 24 h on outcome trajectories. Clinical outcomes include functional outcomes measured according to modified Rankin Scale (mRS) and serious adverse events at follow-up (usually 90 days). Generalized linear mixed models were used with adjustment of source trial as a random effect for clustering to identify the prognostic factors.</p><p><strong>Results: </strong>Among 6,221 participants from BASC, 2,450 patients (mean age 64.1 + 13.1 years, female 36.7%) were included. Baseline hematoma volumes (mL) were 6.8, 13.2, 27.1, and 59.2, respectively, for each class identified by patient profiles: no growth with favorable outcome (52.1%, median growth 0.2 [IQR -0.4 to 1.1] mL, median mRS 2 [IQR 1 to 2]), mild growth with disability (32.6%, 0.8 [-0.8 to 4.6] mL, mRS 4 [4 to 5]), moderate growth with death or disability (13.2%, 11.2 [4.9 to 27.0] mL, mRS 4 [3 to 6]), and large growth with death (2.1%, 35.2 [12.8 to 81.2] mL, mRS 6 [6 to 6]). Patients with moderate growth were younger and more likely to undergo neurosurgery than those in the mild or large growth groups. Baseline hematoma volume was the only significant factor associated with all the hematoma pattern groups.</p><p><strong>Conclusions: </strong>Patients with moderate growth were younger and more likely to receive neurosurgery than those in the mild or large growth groups. Baseline hematoma volume is the most important factor for hematoma growth and clinical outcome.</p>\",\"PeriodicalId\":9683,\"journal\":{\"name\":\"Cerebrovascular Diseases\",\"volume\":\" \",\"pages\":\"1-9\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-08-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cerebrovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000547678\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000547678","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Trajectory of Hematoma Growth and Functional Recovery after Intracerebral Hemorrhage: A Latent Class Analysis of Blood Pressure in Acute Stroke Collaboration Data.
Introduction: Moderate blood pressure (BP) reduction reduces hematoma growth, but this has not been shown to translate into improved functional recovery after intracerebral hemorrhage (ICH). This study aimed to define patient profiles according to hematoma growth and functional recovery patterns, and explore the prognostic factors of the patterns.
Methods: Analysis of the Blood Pressure in Acute Stroke Collaboration (BASC) dataset involved randomized controlled trials of early BP lowering in acute ICH. Latent class analysis was used to identify patient profiles by hematoma volume change from baseline to 24 h on outcome trajectories. Clinical outcomes include functional outcomes measured according to modified Rankin Scale (mRS) and serious adverse events at follow-up (usually 90 days). Generalized linear mixed models were used with adjustment of source trial as a random effect for clustering to identify the prognostic factors.
Results: Among 6,221 participants from BASC, 2,450 patients (mean age 64.1 + 13.1 years, female 36.7%) were included. Baseline hematoma volumes (mL) were 6.8, 13.2, 27.1, and 59.2, respectively, for each class identified by patient profiles: no growth with favorable outcome (52.1%, median growth 0.2 [IQR -0.4 to 1.1] mL, median mRS 2 [IQR 1 to 2]), mild growth with disability (32.6%, 0.8 [-0.8 to 4.6] mL, mRS 4 [4 to 5]), moderate growth with death or disability (13.2%, 11.2 [4.9 to 27.0] mL, mRS 4 [3 to 6]), and large growth with death (2.1%, 35.2 [12.8 to 81.2] mL, mRS 6 [6 to 6]). Patients with moderate growth were younger and more likely to undergo neurosurgery than those in the mild or large growth groups. Baseline hematoma volume was the only significant factor associated with all the hematoma pattern groups.
Conclusions: Patients with moderate growth were younger and more likely to receive neurosurgery than those in the mild or large growth groups. Baseline hematoma volume is the most important factor for hematoma growth and clinical outcome.
期刊介绍：
A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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