Analysis Of Factors Influencing The Prognosis Of Patients With Spontaneous Supratentorial Intracerebral Hemorrhage And Construction Of Predictive Models

OBJECTIVE: Spontaneous intracranial hemorrhage(s ICH)is a kind of disease with extremely high mortality and disability,and there are many factors influencing prognosis.At present,most of the research focuses on single factors affecting the prognosis of cerebral hemorrhage,such as hematoma enlargement,the use of antithrombotic drugs,CT signs,etc.,but there are few studies on the multiple prognostic factors affecting ICH.Therefore,this study was conducted to further elaborate the risk of cerebral hemorrhage and prognosis analysis and create a predictive model of cerebral hemorrhage prognosis and death.METHODS: Retrospectively and continuously included in the Department of Neurology,Tongji Hospital,Huazhong University of Science and Technology,from 2016.12 to 2018.4,diagnosed as Spontaneous intracranial hemorrhage.The clinical baseline data,imaging data,specific treatment status and telephone follow-up data were recorded.The prognosis was assessed by m Rs score In the sixth month.The m Rs were divided into groups with good prognosis(m Rs ≤ 2)and poor prognosis(m Rs ≥ 3);basic recovery group(m Rs ≤ 1),and disabled(2 ≤m Rs≤5)and death group(m Rs=6 points);non-death group(0≤m Rs≤5 points)and death group(m Rs=6 points),using univariate analysis and multi-factor logistic regression analysis,and finally obtaining independent prediction of factors associated with prognosis.RESULTS: A retrospective inclusion of 161 patients with cerebral hemorrhage,including 9 patients who were lost to follow-up,excluded 11 patients with Infratentorial hemorrhage,and The remaining 141 patients had complete data.87 patients(61.7%)had a good prognosis,54 patients(38.3%)had a poor prognosis;57 patients(40.4%)had a basic recovery,69 patients(48.9%)had a disability,and 15 patients(10.6%)died.Univariate analysis showed that location of cerebral hemorrhage,volume,midline shift,pulse rate,CT signs,such as irregular hematoma shape(including island sign,satellite sign,irregular hematoma),bleeding extended into the ventricle or subarachnoid,admitted White blood cells,platelets,N/L ratio(neutrophil and lymphocyte ratio),e GFR,NIHSS score at admission,ESRD,SIRS and various treatments(conservative treatment,extraventricular drainage,hematoma minimally invasive suction flow,etc.),Brain atrophy(frontal ratio,third ventricle Sylvian fissure distance)is a risk factor affecting the prognosis of patients with spontaneous cerebral hemorrhage;the relevant factors were included in the logistic regression analysis,and the OR value was adjusted to show the independent prognostic factors of spontaneous cerebral hemorrhage including Hematoma mixed density(black hole sign,blend sign,liquid level,hematoma heterogeneity)(OR=0.189,95% CI: 0.043~0.832,P=0.028),NIHSS score(OR=1.496,95% CI: 1.271~1.761,P=0.000),D-Dimer(OR=1.204,95% CI: 1.010~1.436,P=0.038),irregular hematoma shape(island sign,satellite sign,hematoma irregularity)(OR=5.654,95% CI: 1.315~24.303,P=0.02),hematoma volume(OR=1.125,95 % CI: 1.041 ~ 1.216,P = 0.003),cerebral cortical atrophy(P = 0.036),in particular severe brain atrophy(OR = 18.440,95% CI: 1.734 ~ 196.115,P = 0.016),midline shift(P =0.014);Compared with patients with a midline shift of 0-1.43 mm,the risk of poor prognosis of cerebral hemorrhage with a midline shift of 1.43-2.42 mm was higher(OR=10.526,95% CI: 1.615~68.602,P =0.014);The above factors were used to construct a prognostic model of cerebral hemorrhage.The sensitivity and specificity of this model for predicting poor prognosis of cerebral hemorrhage were 87.5% and 87.4%,respectively.Independent factors affecting 6-month mortality from cerebral hemorrhage included platelet counts at admission(OR=0.974,95% CI: 0.950-0.999,P=0.038),NIHSS score(OR=1.454,95% CI: 1.055-1.995,P =0.027),e GFR(OR=0.925,95% CI: 0.875-0.978,P=0.006),with IVH(OR=33.841,95% CI: 1.460-784.514,P=0.028),third ventricle Sylvian fissure distance ≥38.93mm(OR=0.071,95% CI: 0.005-0.924,P=0.043).Inflammatory indicators such as white blood cell count and increased N/L ratio at admission may increase the risk of cerebral hemorrhage mortality(respectively P = 0.05,0.093),compared with traditional conservative treatment,hematoma minimally invasive suction flow may reduce the risk of cerebral hemorrhage mortality(P = 0.053);The sensitivity and specificity of the model for predicting cerebral hemorrhage mortality were 90.0% and 94.4%,respectively.Conclusion: The NIHSS score on admission,D-Dimer,and CT imaging features such as hematoma mixed density and hematoma irregularity,Hematoma volume,brain atrophy,and midline shift are independent risk factors for the prognosis of cerebral hemorrhage.Patients with reduced platelet count on admission,high NIHSS score,hemorrhage with IVH,and third ventricle Sylvian fissure distance less than 38.93 mm can increase mortality of cerebral hemorrhage,Substituting the above factors into the regression equation can well predict poor prognosis and mortality in patients with ICH;other factors that may affect mortality,including white blood cell count,N/L ratio,hematoma minimally invasive suction flow,still require more clinical results to support.