Lee Hock, Keong
(2009)
Augmentation index in spontaneous intracerebral
hemorrhage and its relationship with outcome.
Masters thesis, 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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