原发性脑干出血——来自中风登记的机构系列和结果决定因素的评估

N. Gupta, A. Pradhan, Sufyan Ibrahim, Benak S, Ajay Hegde, G. Menon
{"title":"原发性脑干出血——来自中风登记的机构系列和结果决定因素的评估","authors":"N. Gupta, A. Pradhan, Sufyan Ibrahim, Benak S, Ajay Hegde, G. Menon","doi":"10.1177/25166085231186377","DOIUrl":null,"url":null,"abstract":"Primary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients. A single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant. A total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, ( P < .001) large clot volume (>10 mL) ( P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) ( P < .03) was found to have significant correlation with mortality. Brainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. Low GCS on admission is the most important and independent predictor of mortality and poor outcome.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Primary Brainstem Hemorrhage—An Institutional Series From a Stroke Register and Evaluation of Outcome Determinants\",\"authors\":\"N. Gupta, A. Pradhan, Sufyan Ibrahim, Benak S, Ajay Hegde, G. Menon\",\"doi\":\"10.1177/25166085231186377\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Primary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients. A single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant. A total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, ( P < .001) large clot volume (>10 mL) ( P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) ( P < .03) was found to have significant correlation with mortality. Brainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. Low GCS on admission is the most important and independent predictor of mortality and poor outcome.\",\"PeriodicalId\":93323,\"journal\":{\"name\":\"Journal of stroke medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-08-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of stroke medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/25166085231186377\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of stroke medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/25166085231186377","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

原发性脑干出血(PBH)预后不良,需要积极治疗是一个有争议的问题,特别是在资源有限的发展中国家。本研究的目的是分析59例连续患者PBH后死亡率预测的预后因素。单一机构、回顾性、队列研究,研究期为6年(2016-2021)。所有在中脑、脑桥或髓质单独或合并有计算机断层扫描证实的脑内血肿的患者都被纳入研究。结果采用改良的Rankin评分(mRS)进行分析,分为好(mRS 0、1、2和3)、差(mRS 4和5)和死亡。采用单因素回归分析后再进行多因素回归分析,P值< 0.05为差异有统计学意义。共有59例诊断为原发性脑干血肿的患者被纳入研究。59例患者中,男性40例(67.79%),女性19例(32.2%),平均年龄55.51±13.46岁(29 ~ 93岁)。入院时GCS评分中位数为6分。18例(30.50%)没有明确的高血压病史。脑干血肿最常见的部位是脑桥47(79.9%),其次是脑桥-中脑合并(10.2%)。平均血块体积为7.78±6.5 mL。18例(28.8%)患者出现第四心室扩张,其中15例(27.2%)发生脑积水。所有患者均采用保守治疗。3个月时,34例(57.62%)患者死亡,25例(42.37%)患者存活,其中仅有12例预后良好(mRS 0-3)。除了GCS评分< 8分(P < 0.001)、大血块体积(>10 mL) (P < 0.001)、入院时收缩压高、脑室内扩张外,入院时中性粒细胞与淋巴细胞比值(NLR)高(P < 0.01)与死亡率有显著相关。脑干出血死亡率高,临床预后良好的病例很少。入院时GCS、凝块体积、病因高血压和高NLR是不良预后因素。入院时低GCS是死亡率和预后不良的最重要和最独立的预测指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Primary Brainstem Hemorrhage—An Institutional Series From a Stroke Register and Evaluation of Outcome Determinants
Primary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients. A single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant. A total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, ( P < .001) large clot volume (>10 mL) ( P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) ( P < .03) was found to have significant correlation with mortality. Brainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. Low GCS on admission is the most important and independent predictor of mortality and poor outcome.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信