Prognostic factors of spontaneous intracerebral haemorrhage in haemodialysis patients and predictors of 30‐day mortality

Huang, Bing‐Shen; Liao, Chun-Ta; Huang, Wen‐Yi; Hsu, Yung‐Heng; Hsu, Jen-Te; Yen, Hsiu-Chuan; Lin, Chih-Chuan

doi:10.1111/j.1445-5994.2007.01536.x

Cited by 29 publications

(41 citation statements)

References 22 publications

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“…This study therefore concluded that hyperglycaemia is probably a stress response to neurological injury. Moreover, a retrospective study in Taiwan [23] failed to reveal an independent relationship with 30-day mortality rates. The results in the present study show that admission hyperglycaemia is independently associated with early mortality.…”

Section: Discussionmentioning

confidence: 99%

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

et al. 2009

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Aims/hypothesis Admission hyperglycaemia is associated with a poor outcome in patients with ischaemic stroke. However, its prognostic effects after intracerebral haemorrhage (ICH) are still unclear. Methods We prospectively enrolled patients with ICH at 33 centres in Korea between October 2002 and March 2004. A total of 1,387 patients who had ICH and underwent brain computed tomography within 48 h of symptom onset were included in the study (n=1,387). Clinical information and radiological findings were collected at admission. Glucose levels were examined in relation to early (up to 30 days after ictus) and long-term (after 30 days) mortality rates using Cox regression analysis. To eliminate short-term effects, long-term mortality rate analysis was performed on surviving patients for more than 30 days. Results The long-term mortality rate was 21.1% after a mean follow-up of 434.3±223.2 days and was found to increase significantly with glucose quartile (p<0.001). Admission glucose level was an independent risk factor for early mortality (per mmol/l; adjusted HR 1.10 [95% CI 1.01-1.19]), but not for long-term mortality. Moreover, when analysis was restricted to patients without diabetes, glucose level was found to be an independent risk factor for post-ICH mortality (n=1,119; adjusted HR 1.10 [95% CI 1.03-1.17]) and had marginal significance for early (p= 0.053) and long-term mortality (p=0.09). Conclusions/interpretation We found that admission glucose levels were associated with early mortality after ICH. In patients without diabetes, admission glucose levels were associated with long-term mortality. We therefore suggest that intensive lowering of glucose level should be further investigated in ICH patients.

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Section: Discussionmentioning

confidence: 99%

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

et al. 2009

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“…Although ICH incidence and long-term outcomes in maintenance HD patients have been well described, there have been few reports on the detailed clinical features of maintenance HD patients who experience ICH. Although previous studies show that the mortality rate in HD patients with acute ICH is high [14,15,16], no evidence has yet indicated that HD is an independent factor associated with early death on multivariate analysis. Moreover, some results of studies varied widely.…”

Section: Introductionmentioning

confidence: 99%

Maintenance Hemodialysis Independently Increases the Risk of Early Death after Acute Intracerebral Hemorrhage

et al. 2013

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Background: It is unknown whether the clinical features and outcomes of intracerebral hemorrhage (ICH) patients who undergo maintenance hemodialysis (HD) at the time of ICH are similar to those of general ICH patients. Methods: We retrospectively examined the medical records of ICH patients admitted to the Stroke Center of Kawasaki Medical School Hospital within 7 days ofICHonset between April 2004 and June 2011. Patients were classed as HD or non-HD, and clinical characteristics were compared between the two groups. ICH volume was measured on admission CT and follow-up CT scan (<24 h after admission). Hematoma enlargement was defined as a hematoma that increased by more than 33% of its initial volume. Early death was defined as all-causedeath within 14 days of ICH onset. The factors associated with early death were determined using multivariate logistic regression analysis. Results: Five hundred and seven patients (320 males; 69.0 years old, interquartile range 59.0-79.0) were enrolled in the study. Thirty-six (7.2%) were receiving maintenance HD at the time of ICH and formed the HD group, and the remaining 471 patients formed the non-HD group. Use of antithrombotic agents prior to ICH was more common in the HD group than in the non-HD group (41.7 vs. 21.9%; p = 0.012). Brainstem (30.6 vs. 11.3%; p = 0.003) and lobar (19.4 vs. 6.6%; p = 0.013) hematoma locations were more common in the HD group than in the non-HD group. Enlargement of ICH volume was more common in the HD group than in the non-HD group (25.8 vs. 10.2%; p = 0.015). Early death was more common in the HD group than in the non-HD group (33.3 vs. 9.3%; p < 0.001). On the multivariate logistic regression analysis adjusted for age, sex and renal dysfunction, National Institutes of Health Stroke Scale score >20 [odds ratio (OR) 27.40, 95% confidence interval (CI) 9.69-77.44; p < 0.001], ICH volume >30 ml (OR 9.53, 95% CI 3.82-23.77; p < 0.001), HD (OR 6.42, 95% CI 1.39-29.76; p = 0.017), the use of antithrombotic agents (OR 3.04, 95% CI 1.22-7.56; p = 0.017) and glucose >150 mg/dl (OR 2.51, 95% CI 1.01-6.26; p = 0.047) were independent factors associated with early death. Conclusion: Maintenance HD is independently associated with early death in ICH patients.

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“…What's more, the ROC curve displayed the threshold value of perihematma CBV was 1.24 ml·100 g −1 , and that of CBF Our study had the following limitations. The sample tcome in acute SICH are hematoma volume, Glasgow Coma Scale score, age, mass effect, and the presence of hydrocephalus [12,13]. We did not collect Glasgow Coma Scale data, and due to the small sample size, binary logical analysis was not applied for the risk factors for outcome.…”

Section: Discussionmentioning

confidence: 99%

CT Perfusion Imaging Predicts One-Month Outcome in Patients with Acute Spontaneous Hypertensive Intracerebral Hemorrhage

Xu¹,

Chen²,

Wang³

et al. 2013

ACT

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Purpose: Little is known about the relationship between perihematomal perfusion parameters in acute spontaneous hypertensive intracerebral hemorrhage patients and recent outcome. The purpose of this study was to evaluate the relationship between the perfusion parameters of the perihematomal brain tissue and the recent prognosis of patients with acute spontaneous hypertensive intracerebral hemorrhage (shICH) using CT perfusion (CTP) imaging. Methods: Twenty-six patients with clinical and CT diagnosed supratentorial shICH received CTP scanning within 8 -19 h after symptom onset. At the maximum levels of the hematoma, cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) of perihematomal area (isodense within 1cm rim of perilesion area on plain CT) and contralateral mirrored hemisphere were measured, and rCBF, rCBV, rMTT were calculated (ipsilateral/contralateral). The one-month follow-up in accordance with daily living table (Barthel index, BI) by telephone was recorded. Results: The CBV, CBF, and MTT values of perihematoma area were (1.61 ± 1.53) ml·100 g , and (9.12 ± 2.57) s, respectively. There was significantly decreased CBV, CBF, and prolonged MTT in the perihematomal zone against contralateral hemisphere (Z CBV = −2.603, Z CBF = −4.178, t MTT = 4.747, all P < 0.05). Wilcoxon ranksum test displayed that perihematomal absolute values of CBV, CBF were indicative of recent prognosis (Z CBV = −3.40, Z CBF = −2.98, both P < 0.01), but MTT, rCBF, rCBV, rMTT showed no correlation (all P > 0.05). The areas under ROC curve (AUC) of CBV, CBF were 0.897, 0.848, respectively. When the threshold value of perihematma CBV was 1.24 ml·100 g −1 , the sensitivity was 66.67% and the specificity was 100%, the threshold value of CBF was 8.44 ml·100 g), the sensitivity was 100% and the specificity was 72.70%. Conclusion: CTP can predict the recent prognosis of shICH patients. Within a certain range, the recent prognosis declines with the increment of CBV CBF values.

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Prognostic factors of spontaneous intracerebral haemorrhage in haemodialysis patients and predictors of 30‐day mortality

Abstract: The outcome score is a simple clinical grading scale that allows risk stratification of HD patients presenting with ICH. This scale could be used to design treatment protocols and clinical research studies of ICH in HD patients.

Cited by 29 publications

References 22 publications

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

Maintenance Hemodialysis Independently Increases the Risk of Early Death after Acute Intracerebral Hemorrhage

CT Perfusion Imaging Predicts One-Month Outcome in Patients with Acute Spontaneous Hypertensive Intracerebral Hemorrhage

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