ABSTRACT
BACKGROUND AND STUDY AIMS: Spontaneous intracerebral hemorrhage (ICH) represents the most fatal kind of stroke, and there is still no treatment available that improves the outcome. Statins are cholesterol reducers, and during the last few years many additional effects have been demonstrated that might be neuroprotective. We designed a pilot clinical study in order to evaluate whether the administration of statins is associated with a better outcome. PATIENTS AND METHODS: From August to December 2006 we carried out a prospective/retrospective non-randomized clinical study. The prospective group was treated with rosuvastatin (20 mg) and the retrospective control group was taken from our clinical records with a relation of 1:3. We included patients of both sexes, aged > or =15 years with proven ICH in CT-scan. Exclusion criteria were a history of neoplasm, head injury four weeks before admission, non-hypertensive reasons, brainstem hemorrhage, steroid administration, cranial surgery, initial hydrocephalus, and NIHSS > or =30. RESULTS: We analyzed 18 patients treated with rosuvastatin and 57 controls with similar basic characteristics. The mortality rate during hospitalization was 1 (5.6%) patient in the statin group and 9 (15.8%) in the control group; the hazard ratio adjusted by the initial Glasgow Coma Scale (GCS), intubation, admission in intensive care unit, disruption into the subarachnoid space was 0.20 (95% CI 0.02-1.67). The odds ratio for NIHSS > or =15 at release was 0.04 (95% CI 0.003-0.93). CONCLUSIONS: The use of statins during the acute phase of ICH could be associated with a better outcome. Further clinical trials are necessary to confirm a possible therapeutic effect and evaluate the toxicity of statins.
Subject(s)
Cerebral Hemorrhage/drug therapy , Fluorobenzenes/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Pyrimidines/therapeutic use , Sulfonamides/therapeutic use , Adult , Aged , Antihypertensive Agents/therapeutic use , Cerebral Hemorrhage/mortality , Female , Glasgow Coma Scale , Hospital Mortality , Humans , Male , Middle Aged , Odds Ratio , Pilot Projects , Proportional Hazards Models , Prospective Studies , Retrospective Studies , Rosuvastatin Calcium , Sample Size , Stroke/drug therapy , Stroke/mortality , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
INTRODUCTION: Intracerebral hemorrhage (ICH) is the most lethal type of stroke. There are some clinical and radiological factors related to mortality. The time for obtaining medical care could be related with poor prognosis, but there are not available studies in Hispanics that evaluated this one. AIM: To determinate the association between epidemiological factors, time to obtain medical care, origin, and clinical characteristics with hospital mortality due to ICH. SUBJECTS AND METHODS: Study of cases and controls in a regional third level center, between January 2000 and December 2006 with patients of both sexes, older than 15 years with tomographic diagnosis of ICH. We excluded patients with NIHSS undetermined or traumatic head injury 4 weeks before. We studied demographic variables, time between beginning of symptoms and medical care, origin in kilometers until hospital, clinical characteristics at admission, including Glasgow and NIHSS. RESULTS: We analyzed 74 men and 101 women with mean age of 65 years. The etiology was hypertension in 77.4% and localization lobar in 39.4%. Eighty-five percent receipt medical care after 3 hours and 75.4% came from a radius < 100 km. Mortality in hospital was 16.6% with an explicative model of regression that included blood pressure < 130/80 mmHg, intubation, Glasgow < 9 at admission or NIHSS > 15, and hospitalization days. CONCLUSIONS: Demographic characteristics, causes, and localization are similar to previously informed series. The time for obtaining medical care is far from ideal, this could delay treatment; allow progression of disease, and then worse prognosis.
Subject(s)
Cerebral Hemorrhage/mortality , Cerebral Hemorrhage/therapy , Adult , Aged , Aged, 80 and over , Case-Control Studies , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/epidemiology , Female , Hospital Mortality , Hospitals , Humans , Male , Mexico , Middle Aged , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
La hemorragia intracerebral (HIC) espontánea es la forma más letal de enfermedad cerebrovascular.Existen factores clínicos y radiológicos descritos asociados a mortalidad. El tiempo en recibir atención podría relacionarse con peor pronóstico; sin embargo, no existen estudios en la población latina que hayan analizado esta asociación. Objetivo.Determinar la asociación entre factores epidemiológicos, el tiempo de atención, la procedencia y características clínicas con la mortalidad hospitalaria por HIC. Sujetos y métodos. Es un estudio de casos y controles en un centro regional de tercer nivel,entre enero de 2000 y diciembre de 2006, con pacientes de ambos sexos, mayores de 15 años, con diagnóstico tomográfico de HIC. Se excluyeron aquéllos con la escala del Instituto Nacional de Salud para enfermedades cardiovasculares (NIHSS) basal indeterminada o traumatismo craneal en las cuatro semanas previas. Se estudiaron variables demográficas, tiempo entre inicio de síntomas y atención médica, lugar de procedencia en kilómetros y características clínicas en el momento del ingreso, incluyendo la puntuación de Glasgow y NIHSS. Resultados. Analizamos 74 hombres y 101 mujeres con edad promediode 65 años. La etiología fue hipertensión arterial en el 77,3% y localización lobar en el 39,4%. El 84,5% recibió atención despuésde tres horas y el 75,4% procedía de un radio menor de 100 km. La mortalidad hospitalaria fue del 16,6%, con un modeloexplicativo de regresión logística que incluyó: tensión arterial < 130/80 mmHg, intubación, Glasgow < 9 o NIHSS >15en el momento del ingreso y los días de hospitalización. Conclusiones. Las características demográficas, causas y localizaciónse asemejan a lo descrito en la bibliografía. El tiempo de atención dista de lo ideal, lo que puede retrasar el tratamiento,permitir la progresión de la enfermedad y empeorar el pronóstico
Intracerebral hemorrhage (ICH) is the most lethal type of stroke. There are some clinical andradiological factors related to mortality. The time for obtaining medical care could be related with poor prognosis, but there are not available studies in Hispanics that evaluated this one. Aim. To determinate the association between epidemiologicalfactors, time to obtain medical care, origin, and clinical characteristics with hospital mortality due to ICH. Subjects and methods. Study of cases and controls in a regional third level center, between January 2000 and December 2006 with patients of both sexes, older than 15 years with tomographic diagnosis of ICH. We excluded patients with NIHSS undetermined or traumatic head injury 4 weeks before. We studied demographic variables, time between beginning of symptoms and medicalcare, origin in kilometers until hospital, clinical characteristics at admission, including Glasgow and NIHSS. Results. We analyzed 74 men and 101 women with mean age of 65 years. The etiology was hypertension in 77.4% and localization lobar in 39.4%. Eighty-five percent receipt medical care after 3 hours and 75.4% came from a radius < 100 km. Mortality inhospital was 16.6% with an explicative model of regression that included blood pressure < 130/80 mmHg, intubation, Glasgow < 9 at admission or NIHSS > 15, and hospitalization days. Conclusions. Demographic characteristics, causes, and localization are similar to previously informed series. The time for obtaining medical care is far from ideal, this could delaytreatment; allow progression of disease, and then worse prognosis
