Association between the Edinburgh CT and genetic diagnostic criteria for cerebral amyloid angiopathy-associated lobar intracerebral haemorrhage and recurrent intracerebral haemorrhage: an individual patient data meta-analysis.

However, access to MRI is limited.

然而，MRI的使用受到限制。

We aimed to determine whether the Edinburgh CT-only and CT-APOE diagnostic criteria for cerebral amyloid angiopathy-related lobar intracerebral haemorrhage are associated with recurrent intracerebral haemorrhage.

我们旨在确定爱丁堡仅CT和CT-APOE诊断标准是否与脑淀粉样蛋白血管病相关脑叶出血的复发性脑出血有关。

Methods

We did a meta-analysisof individual patient data from cohort studies identified at the 2018 International cerebral amyloid angiopathy conference in Lille, France, assessing patients with lobar intracerebral haemorrhage with available diagnostic CT imaging that had been, or could be, rated for the Edinburgh cerebral amyloid angiopathy criteria imaging features, and with follow-up data for recurrent intracerebral haemorrhage and death.

我们在2018年法国里尔国际脑淀粉样蛋白血管病会议上，对队列研究的个体患者数据进行了荟萃分析，评估了有可用诊断CT成像的脑叶出血患者，这些成像已被或可以被评定为爱丁堡脑淀粉样蛋白血管病标准的成像特征，并且有复发性脑出血和死亡的随访数据。

Eligible patients were aged 16 years or older with first or recurrent spontaneous lobar intracerebral haemorrhage diagnosed by non-contrast brain CT, with no evidence of an underlying cause other than cerebral small vessel disease.

符合条件的患者年龄在16岁或以上，首次或复发的自发性叶状脑内出血通过无对比剂的脑部CT确诊，除了脑小血管病外，没有其他潜在原因的证据。

Collaborators provided individual patient-level data.

合作者提供了个别患者的病例级数据。

The primary outcome was first recurrent intracerebral haemorrhage occurring at least 30 days after the index event, analysed using primary two-stage (cohort-level) and secondary one-stage (pooled) meta-analyses with multivariable regression models with a competing risk of death, adjusted for age, sex, and CT small vessel disease score.

主要结果是首次复发性脑出血，发生在索引事件至少30天后，使用两级（队列级）和次要一级（合并）元分析进行分析，采用多变量回归模型，考虑死亡的竞争风险，根据年龄、性别和CT小血管疾病评分进行调整。

Pooled analyses were adjusted for previous intracerebral haemorrhage, dementia, hypertension, and cohort clustering.

合并分析调整了先前的脑出血、痴呆、高血压和队列聚集。

All analyses were done in R Project for Statistical Computing (version 4.5.0).

所有分析均在R统计计算项目（版本4.5.0）中完成。

Results

We included eight cohorts from Austria, France, Germany, Italy, the UK, and the USA, with 1705 eligible patients for the CT-only criteria.

我们纳入了来自奥地利、法国、德国、意大利、英国和美国的八个队列，共有1705名符合CT单独标准的合格患者。

In the primary two-stage meta-analysisof the CT-only criteria (562 patients from three European cohorts, median age 76 years [IQR 68-82], 282 [50%] female and 280 [50%] male), 69 patients had a recurrent intracerebral haemorrhage over 1381 person-years' follow-up.

在仅CT标准的初步两阶段荟萃分析中（来自三个欧洲队列的562名患者，中位年龄为76岁[四分位数间距68-82]，282名[50%]女性和280名[50%]男性），在1381人年的随访期间，有69名患者发生了复发性脑出血。

The proportion with recurrent intracerebral haemorrhage during 5-year follow-up in the intermediate-risk and high-risk CT-only cerebral amyloid angiopathy criteria group was 48 (16%) of 307 patients compared with 21 (8%) of 255 patients in the low-risk group (adjusted sub-distribution hazard ratio[HR] 1·79, 95% CI 1·05-3·05, p=0·032).

在5年的随访期间，中等风险和高风险仅CT脑淀粉样蛋白血管病标准组中有48名（16%）患者复发脑出血，而低风险组中有21名（8%）患者复发脑出血（调整后亚分布风险比[HR] 1·79，95%置信区间1·05-3·05，p=0·032）。

In the one-stage meta-analysisof the CT-only criteria (1620 patients with lobar intracerebral haemorrhage from eight cohorts, median age 73 years [IQR 62-80], 763 [47%] female and 857 [53%] male), 171 patients had a recurrent intracerebral haemorrhage over 3208 person-years' follow-up.

在一阶段仅CT标准的荟萃分析中（来自八个队列的1620名脑叶内出血患者，中位年龄73岁[四分位数间距62-80]，763名[47%]女性和857名[53%]男性），在3208人年的随访期间，有171名患者发生了再发性脑出血。

Cumulative 5-year incidenceof recurrent intracerebral haemorrhage in the low-risk CT-only cerebral amyloid angiopathy criteria group was 45 (12%) of 727 patients compared with 54 (16%) of 513 patients in the intermediate-risk group (adjusted sub-distribution HR 1·68, 95% CI 1·21-2·32; p=0·0018), and 72 (26%) of 380 patients in the high-risk group (adjusted sub-distribution HR 2·97, 1·50-5·89, p=0·0018).

在低风险仅CT脑淀粉样蛋白血管病标准组中，727名患者中有45名（12%）在5年内发生了再发性脑出血；在中风险组中，513名患者中有54名（16%）（调整后亚分布风险比HR 1·68，95% 置信区间CI 1·21-2·32；p=0·0018）；在高风险组中，380名患者中有72名（26%）（调整后亚分布风险比HR 2·97，1·50-5·89，p=0·0018）。

We included six cohorts with 1021 eligible patients for the CT-APOE criteria; 15 patients with missing baseline data were excluded.

我们纳入了六个队列，共有1021名符合CT-APOE标准的合格患者；有15名患者因缺失基线数据被排除在外。

There were insufficient outcomes in individual CT-APOE cohorts to do the two-stage meta-analysis.

在各个CT-APOE队列中，结果数据不足以进行两阶段荟萃分析。

In the one-stage meta-analysisof the CT-APOE criteria (1006 patients, median age 71 years [IQR 58-79, 477 [47%] female and 529 [53%] male), 74 patients had a recurrent intracerebral haemorrhage over 1495 person-years' follow-up.

在对CT-APOE标准进行的一期荟萃分析中（1006名患者，中位年龄71岁[四分位数间距58-79，477名[47%]女性和529名[53%]男性），在1495人年的随访期间，有74名患者发生了再发性脑出血。

Cumulative 3-year incidenceof recurrent intracerebral haemorrhage was 34 (15%) of 320 patients in the high-risk CT-APOE cerebral amyloid angiopathy criteria group versus 14 (8%) of 322 patients in the low-risk group (adjusted sub-distribution HR 2·22 [95% CI 1·36-3·61], p=0·0014).

高风险CT-APOE脑淀粉样蛋白血管病标准组的患者在3年内累积再发性脑出血发生率为34（15%）的320名患者，而低风险组为14（8%）的322名患者（调整后的亚分布HR为2.22 [95% CI 1.36-3.61]，p=0.0014）。

interpretation

The Edinburgh CT-only and CT-APOE diagnostic criteria for cerebral amyloid angiopathy-associated lobar intracerebral haemorrhage were associated with a greater incidenceof recurrent intracerebral haemorrhage.

爱丁堡仅CT和CT-APOE诊断标准用于诊断与脑淀粉样蛋白血管病相关的脑叶内出血与更高的脑内出血复发率相关。

These findings could aid personalised prediction and targeted secondary prevention in standard clinical practice where brain CT is available.

这些发现可能有助于在标准临床实践中，当脑CT可用时，进行个性化预测和针对性的二级预防。

funding

UK Medical Research Council, The Stroke Association, The Wellcome Trust, and The British Heart Foundation.

英国医学研究理事会、中风协会、惠康信托基金会和英国心脏基金会。