초록접수 미리보기
| 22KS-016 |
Risk factors associated with repeated epidural blood patches using autologous blood
성균관대학교 삼성서울병원
Background: An epidural blood patch (EBP) is a procedure to treat intracranial hypotension that does not respond to conservative treatment. EBPs are commonly repeated when the symptoms persist. In this study, we used a large single-center retrospective cohort and evaluated the factors associated with repeated EBPs.
Methods: From January 2010 to December 2020, a total of 596 patients were treated with EBPs for intracranial hypotension. Repeated EBPs were defined as requiring another EBP within 30 days after the first procedure due to persistent or refractory symptoms. We evaluated the factors associated with repeated EBPs in patients with spontaneous intracranial hypotension (SIH), iatrogenic injury, and in those with available myelographies. The risk factors of repeated EBPs were evaluated using the logistic regression analysis.
Results: In a total of 596 patients, 125 (21.1%) patients required repeated EBPs, and 96/278 (34.5%) in SIH and 29/314 (9.2%) in iatrogenic population. In patients with SIH, presence of cerebrospinal fluid (CSF) leakage sites on myelography and leakage site at the thoracic spine were associated with repeated EBPs. (odds ratio [OR], 2.18; 95% confidence interval [CI], 128 95% CI, 1.34gher international normalized ratio (INR) was also shown to increase the risk of repeated EBPs (OR, 1.38; 95% CI 1.02-1.87; P = 0.043). In patients with iatrogenic injury, EBPs on cervical and thoracic spine was associated with increased risk of repeated procedures. (OR, 6.96; 95% CI 1.11-43.5; P = 0.042 and OR, 11.24; 95% CI 2.65-47.68; P = 0.001, respectively). In patients with myelographic images, the presence of leakage site on thoracic spine and high INR were also consistently associated with repeated EBPs (OR, 2.21; 95% CI, 1.15-4.23; P = 0.022 and OR, 1.83; 95% CI, 1.15-2.89; P = 0.013, respectively).
Conclusions: Repeated EBP was more frequently required in patients with SIH. The presence of CSF leakage sites on myelography, leakage site at the thoracic spine, and prolonged INR were associated with repeated EBP in patients with SIH. Further studies are needed to determine factors associated with repeated EBP requirements.
Methods: From January 2010 to December 2020, a total of 596 patients were treated with EBPs for intracranial hypotension. Repeated EBPs were defined as requiring another EBP within 30 days after the first procedure due to persistent or refractory symptoms. We evaluated the factors associated with repeated EBPs in patients with spontaneous intracranial hypotension (SIH), iatrogenic injury, and in those with available myelographies. The risk factors of repeated EBPs were evaluated using the logistic regression analysis.
Results: In a total of 596 patients, 125 (21.1%) patients required repeated EBPs, and 96/278 (34.5%) in SIH and 29/314 (9.2%) in iatrogenic population. In patients with SIH, presence of cerebrospinal fluid (CSF) leakage sites on myelography and leakage site at the thoracic spine were associated with repeated EBPs. (odds ratio [OR], 2.18; 95% confidence interval [CI], 128 95% CI, 1.34gher international normalized ratio (INR) was also shown to increase the risk of repeated EBPs (OR, 1.38; 95% CI 1.02-1.87; P = 0.043). In patients with iatrogenic injury, EBPs on cervical and thoracic spine was associated with increased risk of repeated procedures. (OR, 6.96; 95% CI 1.11-43.5; P = 0.042 and OR, 11.24; 95% CI 2.65-47.68; P = 0.001, respectively). In patients with myelographic images, the presence of leakage site on thoracic spine and high INR were also consistently associated with repeated EBPs (OR, 2.21; 95% CI, 1.15-4.23; P = 0.022 and OR, 1.83; 95% CI, 1.15-2.89; P = 0.013, respectively).
Conclusions: Repeated EBP was more frequently required in patients with SIH. The presence of CSF leakage sites on myelography, leakage site at the thoracic spine, and prolonged INR were associated with repeated EBP in patients with SIH. Further studies are needed to determine factors associated with repeated EBP requirements.
