Subacute Neurological Improvement Predicts Favorable Functional Recovery After Intracerebral Hemorrhage: INTERACT2 Study.

IF 8.9 1区医学 Q1 CLINICAL NEUROLOGY Stroke Pub Date : 2025-03-01 Epub Date: 2025-02-03 DOI:10.1161/STROKEAHA.124.048847

Shoujiang You, Danni Zheng, Xiaoying Chen, Xia Wang, Menglu Ouyang, Qiao Han, Yongjun Cao, Candice Delcourt, Lili Song, Cheryl Carcel, Hisatomi Arima, Chun-Feng Liu, Richard I Lindley, Thompson Robinson, Craig S Anderson, John Chalmers

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Abstract

Background: The frequency and prognostic significance of subacute neurological improvement (SNI) on 90-day outcomes after acute intracerebral hemorrhage are unknown.

Methods: Secondary analyses of participant data from the INTERACT2 trial (Second Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial). SNI included any, moderate, significant, and substantial neurological improvement defined as ≥1, ≥2, ≥3, and ≥4 points decrease, respectively, on the National Institutes of Health Stroke Scale from 24 hours to 7 days after intracerebral hemorrhage. Logistic regression models were used to assess associations of SNI and death or major disability (modified Rankin Scale score of 3-6), major disability (modified Rankin Scale scores, 3-5), and death alone at 90 days. Data are reported as odds ratios and 95% CIs.

Results: Of 2571 patients included in analyses, 1492 (58.0%), 1057 (41.1%), 731 (28.4%), and 490 (19.1%) patients experienced any, moderate, significant, and substantial SNI (24 hours to 7 days) after intracerebral hemorrhage, respectively. After adjustment for key confounders, any SNI was associated with 49%, 25%, and 65% reduced odds of death or major disability (odds ratio, 0.51 [95% CI, 0.42-0.63]), major disability alone (odds ratio, 0.75 [95% CI, 0.63-0.90]), and death (odds ratio, 0.35 [95% CI, 0.24-0.50]), respectively. Moderate, significant, and substantial SNI were also significantly associated with decreased odds of death or major disability at 90 days. The relationship between any SNI and study outcomes was consistent in most subgroups, including age and baseline hematoma volume. Early intensive blood pressure-lowering treatment did not increase the odds of SNI.

Conclusions: SNI from 24 hours to 7 days is common after intracerebral hemorrhage and predicts a lower likelihood of death or major disability.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00716079.

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脑出血后亚急性神经系统改善预示着良好的功能恢复：INTERACT2研究。

背景：急性脑出血后90天亚急性神经系统改善（SNI）的频率和预后意义尚不清楚。方法：对INTERACT2试验（第二次急性脑出血强化降压试验）的参与者数据进行二次分析。SNI包括脑出血后24小时至7天内，在美国国立卫生研究院卒中量表上分别降低≥1、≥2、≥3和≥4分的任何、中度、显著和实质性神经学改善。采用Logistic回归模型评估SNI与死亡或严重残疾（修改的Rankin量表评分为3-6）、严重残疾（修改的Rankin量表评分为3-5）和仅在90天死亡的关系。数据以比值比和95% ci报告。结果：在纳入分析的2571例患者中，分别有1492例（58.0%）、1057例（41.1%）、731例（28.4%）和490例（19.1%）患者在脑出血后出现任何、中度、显著和严重SNI（24小时至7天）。在对关键混杂因素进行校正后，任何SNI分别与49%、25%和65%的死亡或主要残疾（优势比，0.51 [95% CI, 0.42-0.63]）、仅主要残疾（优势比，0.75 [95% CI, 0.63-0.90]）和死亡（优势比，0.35 [95% CI, 0.24-0.50]）相关。中度、严重和严重SNI也与90天死亡或主要残疾的几率降低显著相关。任何SNI与研究结果的关系在大多数亚组中是一致的，包括年龄和基线血肿量。早期强化降压治疗未增加SNI发生率。结论：脑出血后24小时至7天的SNI是常见的，预测死亡或严重残疾的可能性较低。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT00716079。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.