Augmentation index in spontaneous intracerebral hemorrhage and its relationship with outcome.
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Date
2009
Authors
Lee Hock, Keong
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan
Abstract
Intracerebral hemorrhage was the most disabling and least treatable form of stroke. The risk factors for intracerebral hemorrhage were old age, hypertension, diabetes mellitus, hypercholesterolemia, smoking and high alcohol intake which were also associated with arterial stiffu.ess. Augmentation index was one of the surrogate marker for arterial stiffu.ess. The aim of the study was to determine whether high augmentation index was associated with 3-month outcome and mortality in intracerebral hemorrhage. Patients with spontaneous supratentorial intracerebral hemorrhage who was admitted to Hospital University Sciences Malaysia from May 2006 till May 2008 were recruited in the study. All patients were followed up for 3 month. The following data was collected for all patients in a computerized database: demographic parameters (age, sex,), clinical parameters (modifiable risk factors for intracerebral hemorrhage, admission Glasgow Coma Scale score , height, weigh, body mass index, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, bilateral internal carotid blood flow and augmentation index ), laboratory parameters (total white cells count, hemoglobin level, platelet count, random blood sugar, serum sodium, potassium, urea, creatinine, international normalized ratio, activated partial thromboplastin time, serum total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride), radiological parameters (chest X-rays findings ,CT scan brain findings), in-hospital treatment (conservative or surgical treatment), type of surgical treatment (craniotomy or external ventricular drainage), 3-month outcome (Modified Rankin Scale score) and mortality. All data was entered into Statistical Package for Social Sciences version 12. Logistic regression analysis was carried out among significant variables to identify independent predictors of3-month poor outcome and mortality. Sixty patients with spontaneous intracerebral hemorrhage were recruited in this prospective study. Twenty-four patients (40%) had 3-month good outcome (Modified Rankin Scale 0 till4) and thirty-six patients (60%) had poor outcome (Modified Rankin Scale 5 & 6). Twelve (33.3%) out of thirty-six poor outcome patients had high augmentation index. Thirt-eight (63%) patients survived at 3-month follow up and twenty-two (37%) patients passed away in 3-month postictus. Ten (45.5%) out of twentytwo patients that passed away had high augmentation index. Independent predictors of 3- month poor outcome were Glasgow Coma Scale score (OR, 0.7; 95%CI, 0.450 to 0.971; P= 0.035), total white cell count (OR, 1.2; 95%CI, 1.028 to 1.453; P= 0.023), hematoma volume (OR, 1.1; 95%CI, 1.024 to 1.204; P= 0.011). The significant predictors for 3- month ICH mortality were high augmentation index (OR, 8.6; 95%CI, 1.794 to 40.940; P= 0.007) and midline shift (OR, 7.5; 95%CI, 1.809 to 31.004; P= 0.005). Glasgow Coma Scale score , total white cell count and hematoma volume were the most important predictors for 3-month outcome. The significant predictors for 3-month ICH mortality in this study were high augmentation index and midline shift.
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Keywords
Brain hemorrhage,