Analysis Of The Prognostic Factors Of Primary Brainstem Hemorrhage

Objective:Primary brainstem hemorrhage is a catastrophic ICH disease,which is hard to choose management methods and predict prognosis.This study aimed to select the prognostic factors and create prognosis prediction model through collecting and analyzing the clinical data of primary brainstem hemorrhage patients.Based on the finding in the prognosis prediction model and the requirement of clinical practice,our team created a new brainstem hematoma classification method----ZJUSAH(Zhejiang University School of Medicine,Second Affiliated Hospital)classification,which can be utilized to guide the sterotactic aspiration surgery and help predict the prognosis.We also targeted to analyze the curative effect of stereotactic aspiration surgery towards primary brainstem hemorrhage patients and the indications and conditions of surgery.Methods:We consecutively included 212 PBH patients in ZJUSAH in the last 7 years,retrospectively analyzed the data and built up the prediction model of 30-day survival and 90-day consciousness of PBH patients.According to the prognostic factors we had found in part 1,we created a new classification of PBH----ZJUSAH classification.We analysed the prognosis with this classification and modified the classification to provide it better prognosis prediction effect.We further matched the surgical group and conservative group with prognostic factors and then conducted the analysis to demonstrate the curative effect of stereotactic aspiration surgery to primary brainstem hemorrhage.Results:1.In 211 primary brainstem hemorrhage patients,we found that hematoma location(whether of nor in dorsal part of brainstem),hematoma volume,hematoma involving thalamus,APTT value in admission and treatment method can predict the 30-day survival outcome(AUC=0.781,P<0.05);mydriasis,hematoma location(whether of nor in dorsal part of brainstem),hematoma volume,hematoma involving thalamus,GCS in admission,APTT value and Creatinine value in admission can predict the 90-day consciousness outcome(AUC=0.853,P<0.05).2.The new PBH hematoma classification method(ZJUSAH classification)includes both the feather of the location and the volume of hematoma,which can help with both conducting the stereotactic aspiration surgery and guiding predicting the prognosis.The 30-day survival rate and 90-day consciousness rate of ZJUSAH type1 patients are 95% and 63.2% respectively;the 2 data of type 2 patients are 77.8% and51.9% respectively(among which subtype 2A are 66.7% and 66.7%,subtype 2B are63.2% and 26.3%,while subtype 2C are 87.5% and 63.3%,respectively);type patients has 63.2% of 30-day survival rate and 21.3% of 90-consciousness rate(among which subtype 3A are 57.1% and 28.6%,subtype 3B are 55.9% and 11.8%,while subtype 3C are 72.1% and 31.1% respectively).3.The analysis of adjusted and matched data demonstrated that the stereotactic aspiration surgery was able to improve both the 30-day survival(85.9% versus 50.0%,)and 90-day consciousness(39.0% versus 22.1%)outcome significantly(P<0.001 and P=0.03574 respectively).Longer time gap between disease onset and surgery(median values of 30-day survival patients are 53(IQR: 32-87)hours,median values of 30-day death patients are 32(IQR: 24-43)hours,P<0.01)was related with 30-day survival outcome.Smaller volume residue after surgery(median values of 90-day consciousness paitents are 1.5(IQR: 0.6-2.8)ml,median values of 90-day unconsciousness patients are 2.7(IQR: 1.4-4.6)ml,P<0.001)Conclusions:We built up a useful prognostic prediction model to predict the short-term and mid-to-long term prognosis of primary brainstem hemorrhage patients.The new brainstem hematoma CT classification(ZJUSAH classification)could function to help with the stereotactic aspiration of hematoma and help predict the prognosis.Stereotactic aspiration surgery can significantly improve both the short-term prognosis(30-day survival rate)and mid-to-long term prognosis(90-day consciousness rate)of primary brainstem hemorrhage patients.