Circadian variation in clinical features and outcome of intracerebral hemorrhage: The INTERACT studies

Previous studies consistently reported a diurnal variation in the occurrence of intracerebral hemorrhage (ICH), with a morning peak. However, limited knowledge exists on the circadian pattern of ICH severity and outcome. This study aimed to determine possible associations between ICH onset time and admission severity and 90-day outcomes using the combined data set of the pilot and main-phase Intensive blood pressure (BP) reduction in an acute cerebral hemorrhage trial (INTERACT). The ICH onset time was categorized into three groups (1: 00:00–07:59; 2: 08:00–15:59; and 3: 16:00–23:59). We found an association between onset time and low Glasgow Coma Scale score: aOR (time 1: 1.72, 95% CI 1.12–2.66; time 3: 1.95, 95% CI 1.31–2.89, <i>p</i> = 0.003; in comparison to time 2). There was no association between onset time and volume of ICH (adjusted <i>p</i> = 0.354) or 90-day outcomes of death or major disability, and death and major disability separately (all adjusted <i>p</i> &gt; 0.4). The results showed that more severe cases of ICH patients, defined by a reduced level of consciousness, had late afternoon to early morning stroke onset, but this was unrelated to baseline hematoma volume or location. There was no circadian influence on ICH clinical outcome.

既往研究一致报道脑出血（intracerebral hemorrhage, ICH）的发生存在昼夜节律变化，且以晨间为发病高峰。然而，目前学界对ICH严重程度与预后的昼夜节律模式尚缺乏足够认知。本研究旨在利用急性脑出血强化降压试验（Intensive blood pressure reduction in an acute cerebral hemorrhage trial, INTERACT）的预试验与主试验合并数据集，探讨ICH发病时间与入院严重程度及90天预后之间的潜在关联。研究将ICH发病时间划分为三组：组1（00:00–07:59）、组2（08:00–15:59）及组3（16:00–23:59）。分析结果显示，发病时间与低格拉斯哥昏迷量表（Glasgow Coma Scale）评分存在显著关联：以组2为参照，调整后优势比（adjusted Odds Ratio, aOR）分别为组1：1.72，95%置信区间（CI）1.12–2.66；组3：1.95，95%CI 1.31–2.89，P=0.003。发病时间与ICH血肿体积无显著关联（校正后P=0.354），与90天全因死亡或重度残疾、以及单独的死亡或重度残疾预后均无统计学关联（所有校正后P>0.4）。本研究结果表明，以意识水平降低定义的重症ICH患者，其发病时段多集中于午后晚期至清晨早期，但该特征与基线血肿体积及血肿部位均无关，且ICH临床预后不受昼夜节律影响。