Relationship Between Leukoaraiosis And Functional Prognosis Of Spontaneous Intracerebral Hemorrhage

Purpose The severity of Leukoaraiosis（LA）is associated with an increased risk of cerebral hemorrhage after thrombolysis.In addition,LA is an independent risk factor for warfarin-related cerebral hemorrhage in patients who have suffered from ischemic stroke,but there are few studies on the prognosis of spontaneous intracerebral hemorrhage（ICH）patients with LA.This study evaluated the severity of LA by age-related white matter change scores（ARWMC）,evaluated the functional prognosis of ICH patients with modified Rankin（m RS）score,and analyzed the correlation between ARWMC score and ICH patient’s m RS score.This study aim to explore the association between the severity of LA and the effect of functional prognosis of ICH patients,in order to provide possibly fundamental theory for clinical disease prevention and treatment.Methods A total of 218 patients with spontaneous intracerebral hemorrhage（ICH）who were hospitalized in the Department of Neurology,Northern Jiangsu People’s Hospital from 2019.10 to 2020.10 were continuously recruited.While intracerebral hemorrhage breaking into ventricle,the patients are excluded.The patients who previously have experienced cerebral hemorrhage or cerebral infarction are excluded.The patients with renal or hepatic dysfunction are excluded.The patients who lost during the follow-up are excluded.Finally,there were 76 patients were removed.The datas of baseline were collected including sex,age,underlying diseases containing hypertension,type 2 diabetes or atrial fibrillation,personal history about smoking or alcohol abuse,history of oral aspirin,Glasgow Coma Scale（GCS）at admission,National Institutes of Health Stroke Scale（NIHSS）at admission,ICH hemorrhage volume at admission（calculated by coniglobus formula）,low density lipoprotein（LDL）,uric acid,glycated hemoglobin,hypersensitive C-reactive protein,neutrophil count,tumor markers,homocysteine,albumin,lipoprotein a,red cell volume distribution width,D-Dimer,lactate dehydrogenase,cystatin C,etc.The Cronbachαcoefficient was applied to evaluate the internal consistency of the ARWMC scale,the Fazekas scale,and the Van Swieten scale.Then the three scales were used to assess the severity of LA in ICH patients.The m RS score was made use of estimating the 30d and 90d functional prognosis of patients with ICH.The patients with a score of m RS≤2 are defined with good prognosis,and the patients with the score of m RS≥2 are defined with poor prognosis.According to the presence or absence of leukoarais,patients were divided into two groups with and without LA,and the differences in baseline information and functional prognosis of the two groups were compared.The receiver operator curve（ROC）was used to detect the predictive value of CT/MRI-based ARWMC score and30d and 90d functional prognosis of ICH patients.The Youden index（Youden）was used to analyze the best ARWMC cut-off points for poor functional outcomes and good functional outcomes in patients with ICH at 30d and 90d.According to the best cut-off point,ICH patients with leukoaraiosis were divided into two groups with ARWMC≤16.5 and ARWMC>16.5.The differences in clinical characteristics and functional prognosis of the two groups were analyzed and compared.Finally,we used binary logistic regression modeling to analyze the association between risk factors and poor 30d and 90d functional outcome after ICH.Results 1.A total of 142 patients with ICH who met the criteria were included in the study,including 102 patients with LA and 40 patients without LA,45 patients（44.1%）had a good prognosis for 30d in the group with LA,and 27 patients（67.5%）had a good prognosis for 30d in the group without LA.There was a statistical difference between the two groups with a good prognosis at 30d（P=0.012）.There were 61 patients（59.8%）with a good prognosis at 90d in the group with LA,37 patients（92.5%）with a good prognosis at 90 days in the group without LA.There was a statistically significant difference between the two groups with a good prognosis at 90d（P=0.000）.2.Comparison of general clinical data in patients with/without LA:there were statistically significant differences between the two groups about the indices on age,smoking,alcoholism,GCS score,LDL,uric acid,hypersensitivity C reactive protein,D-Dimer,etc.（both P<0.05）.3.The Cronbachαcoefficient was used to compare the internal consistency of the three scales.The Cronbachαcoefficients of the three scales were all above 0.7,indicating that the internal consistency was good.The highest is the Fszekas scale,which reaches 0.910,and the MRI-based ARWMC scale has the lowest score,which is 0.785.4.The area under the ROC curve between the 30d and 90d functional prognosis of ICH patients based on MRI-based ARWMC score was 0.735（95%CI 0.638-0.832,P<0.05）and 0.747（95%CI 0.653-0.841,P<0.05）.The area under the ROC curve between the30d and 90d functional prognosis of ICH patients based on CT-based ARWMC score were 0.726（95%CI 0.629-0.824,P<0.05）and 0.744（95%CI 0.649-0.839,P<0.05）.5.Using Youden index,it was found that ARWMC based on MRI and 30d was 16.5(sensitivity_30d=0.474,1-specificity_30d=0.156),ARWMC based on MRI and 90d was 16.5(sensitivity_90d=0.415,1-Specificity_90d=0.131).The best cut-off point of the ARWMC score for 30d and 90d functional outcomes of ICH patients is 16.5.According to the best cut-off point,patients with LA were divided into two groups:A（ARWMC≤16.5）and B（ARWMC>16.5）.There was a statistically significant difference in m RS scores between the two groups at 30d and 90d（all P<0.05）),suggesting that a higher ARWMC score is associated with poor functional prognosis at 30d and 90d in ICH patients.Comparison of general clinical data between groups A and B showed that there were statistically significant differences between the two groups of patients with indicators such as age,hypersensitive C-reactive protein and albumin（both P<0.05）.6.The binary logistic regression model was used to analyze the risk factors affecting the poor prognosis of ICH patients with LA at 30d and 90d.The ARWMC score based on MRI is closely related to poor functional prognosis at 30d.Age,gender,hypertension,type 2 diabetes,history of smoking,history of alcohol abuse,etc.have no statistically significant difference with poor functional prognosis at 30d.Patients with high ARWMC scores have poor functional prognosis at 30ds.The poor 30d functional prognosis of patients with high ARWMC score was 1.208 times that of patients with low ARWMC score（P=0.000,95%CI 1.093-1.336）.ARWMC score and age are closely related to poor 90d functional prognosis in patients with ICH;gender,hypertension,type 2 diabetes,hemorrhage volume,history of smoking,history of alcohol abuse,etc.have no statistically significant difference with poor 90d functional prognosis.The poor90d functional prognosis of patients with high ARWMC score was 1.154 times that of patients with low ARWMC score（P=0.007,95%CI 1.040-1.280）.Conclusion 1.The functional prognosis of ICH patients with LA is worse than that of ICH patients without LA.2.The ARWMC scale has good internal consistency,which is more valuable for assessing the prognosis of ICH patients at 30d and 90d.3.ICH patients with ARWMC>16.5 had worse prognosis than ICH patients with lower ARWMC scores at 30d and 90d.4.Age and high ARWMC score are the risk factors for poor prognosis of ICH patients at30d and 90d.