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The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage
BACKGROUND AND PURPOSE: There are no generally accepted criteria for the etiologic classification of intracerebral hemorrhage (ICH). For this reason, we have developed a set of etiologic criteria and have applied them to a large number of patients to determine their utility. METHODS: The H-ATOMIC cl...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898692/ https://www.ncbi.nlm.nih.gov/pubmed/27275863 http://dx.doi.org/10.1371/journal.pone.0156992 |
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author | Martí-Fàbregas, Joan Prats-Sánchez, Luis Martínez-Domeño, Alejandro Camps-Renom, Pol Marín, Rebeca Jiménez-Xarrié, Elena Fuentes, Blanca Dorado, Laura Purroy, Francisco Arias-Rivas, Susana Delgado-Mederos, Raquel |
author_facet | Martí-Fàbregas, Joan Prats-Sánchez, Luis Martínez-Domeño, Alejandro Camps-Renom, Pol Marín, Rebeca Jiménez-Xarrié, Elena Fuentes, Blanca Dorado, Laura Purroy, Francisco Arias-Rivas, Susana Delgado-Mederos, Raquel |
author_sort | Martí-Fàbregas, Joan |
collection | PubMed |
description | BACKGROUND AND PURPOSE: There are no generally accepted criteria for the etiologic classification of intracerebral hemorrhage (ICH). For this reason, we have developed a set of etiologic criteria and have applied them to a large number of patients to determine their utility. METHODS: The H-ATOMIC classification includes 7 etiologic categories: Hypertension, cerebral Amyloid angiopathy, Tumour, Oral anticoagulants, vascular Malformation, Infrequent causes and Cryptogenic. For each category, the etiology is scored with three degrees of certainty: Possible((3)), Probable((2)) and Definite((1)). Our aim was to perform a basic study consisting of neuroimaging, blood tests, and CT-angio when a numerical score (SICH) suggested an underlying structural abnormality. Combinations of >1 etiologic category for an individual patient were acceptable. The criteria were evaluated in a multicenter and prospective study of consecutive patients with spontaneous ICH. RESULTS: Our study included 439 patients (age 70.8 ± 14.5 years; 61.3% were men). A definite etiology was achieved in 176 (40.1% of the patients: Hypertension 28.2%, cerebral Amyloid angiopathy 0.2%, Tumour 0.2%, Oral anticoagulants 2.2%, vascular Malformation 4.5%, Infrequent causes 4.5%). A total of 7 patients (1.6%) were cryptogenic. In the remaining 58.3% of the patients, ICH was attributable to a single (n = 56, 12.7%) or the combination of ≥2 (n = 200, 45.5%) possible/probable etiologies. The most frequent combinations of etiologies involved possible hypertension with possible CAA (H(3)A(3), n = 38) or with probable CAA (H(3)A(2), n = 29), and probable hypertension with probable OA (H(2)O(2), n = 27). The most frequent category with any degree of certainty was hypertension (H(1+2+3) = 80.6%) followed by cerebral amyloid angiopathy (A(1+2+3) = 30.9%). CONCLUSIONS: According to our etiologic criteria, only about 40% patients received a definite diagnosis, while in the remaining patients ICH was attributable to a single possible/probable etiology or to more than one possible/probable etiology. The use of these criteria would likely help in the management of patients with ICH. |
format | Online Article Text |
id | pubmed-4898692 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-48986922016-06-16 The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage Martí-Fàbregas, Joan Prats-Sánchez, Luis Martínez-Domeño, Alejandro Camps-Renom, Pol Marín, Rebeca Jiménez-Xarrié, Elena Fuentes, Blanca Dorado, Laura Purroy, Francisco Arias-Rivas, Susana Delgado-Mederos, Raquel PLoS One Research Article BACKGROUND AND PURPOSE: There are no generally accepted criteria for the etiologic classification of intracerebral hemorrhage (ICH). For this reason, we have developed a set of etiologic criteria and have applied them to a large number of patients to determine their utility. METHODS: The H-ATOMIC classification includes 7 etiologic categories: Hypertension, cerebral Amyloid angiopathy, Tumour, Oral anticoagulants, vascular Malformation, Infrequent causes and Cryptogenic. For each category, the etiology is scored with three degrees of certainty: Possible((3)), Probable((2)) and Definite((1)). Our aim was to perform a basic study consisting of neuroimaging, blood tests, and CT-angio when a numerical score (SICH) suggested an underlying structural abnormality. Combinations of >1 etiologic category for an individual patient were acceptable. The criteria were evaluated in a multicenter and prospective study of consecutive patients with spontaneous ICH. RESULTS: Our study included 439 patients (age 70.8 ± 14.5 years; 61.3% were men). A definite etiology was achieved in 176 (40.1% of the patients: Hypertension 28.2%, cerebral Amyloid angiopathy 0.2%, Tumour 0.2%, Oral anticoagulants 2.2%, vascular Malformation 4.5%, Infrequent causes 4.5%). A total of 7 patients (1.6%) were cryptogenic. In the remaining 58.3% of the patients, ICH was attributable to a single (n = 56, 12.7%) or the combination of ≥2 (n = 200, 45.5%) possible/probable etiologies. The most frequent combinations of etiologies involved possible hypertension with possible CAA (H(3)A(3), n = 38) or with probable CAA (H(3)A(2), n = 29), and probable hypertension with probable OA (H(2)O(2), n = 27). The most frequent category with any degree of certainty was hypertension (H(1+2+3) = 80.6%) followed by cerebral amyloid angiopathy (A(1+2+3) = 30.9%). CONCLUSIONS: According to our etiologic criteria, only about 40% patients received a definite diagnosis, while in the remaining patients ICH was attributable to a single possible/probable etiology or to more than one possible/probable etiology. The use of these criteria would likely help in the management of patients with ICH. Public Library of Science 2016-06-08 /pmc/articles/PMC4898692/ /pubmed/27275863 http://dx.doi.org/10.1371/journal.pone.0156992 Text en © 2016 Martí-Fàbregas et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Martí-Fàbregas, Joan Prats-Sánchez, Luis Martínez-Domeño, Alejandro Camps-Renom, Pol Marín, Rebeca Jiménez-Xarrié, Elena Fuentes, Blanca Dorado, Laura Purroy, Francisco Arias-Rivas, Susana Delgado-Mederos, Raquel The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage |
title | The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage |
title_full | The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage |
title_fullStr | The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage |
title_full_unstemmed | The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage |
title_short | The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage |
title_sort | h-atomic criteria for the etiologic classification of patients with intracerebral hemorrhage |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898692/ https://www.ncbi.nlm.nih.gov/pubmed/27275863 http://dx.doi.org/10.1371/journal.pone.0156992 |
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