Acute Phase Prognosis And Its Relevant Factors Of Intraventricular Hemorrhage After Spontaneous Intracerebral Hemorrhage

BackgroundSpontaneous intracerebral hemorrhage (sICH) is a clinical emergency with high incidence and mortality urgently awaiting effective therapies. Intraventricular hemorrhage (IVH), as one of its severe complications, independently predicts the disastrous consequences and mortality of ICH. An array of studies have showed that patients suffering IVH after sICH carry higher loads of white blood cells, thrombin-antithrombin complex, fibrinogen-antifibrinogen complex, D-dimer, random blood sugar, and more severe leukoaraiosis. And there are also reports revealing secondary IVH after sICH associated with early phase hematoma expansion, QT interval elongation on ECG manifestation, end stage kidney disease, hypomagnesium, high baseline blood pressure. However, whether these factors attribute to the prognosis has not come into a universal conclusion yet.ObjectiveTo explore the acute phase prognosis and its relevant factors of intraventricular hemorrhage after spontaneous intracerebral hemorrhage in conservatively treated patients.MethodsRetrospectively collect new-admitted patients diagnosed sICH with head Computed Tomography (CT) between July,2014 and February,2015. The patients, whose clinical information is collected, are divided into two groups, sICH with or without intraventricular extension. Coniglobus formula is employed to evaluate hematoma volume, as well as IVH score and mGreab for IVH volume. National Institute of Health stroke scale (NIHSS) and Glasgow Coma Scale (GCS) are for accessing the clinical severity of all the patients. Statistic methods including both univariate and multivariate analysis are utilized accordingly.Results131 patients are included in our study with mean age 60.1+13.9 and male gender proportion of 61.8%.48 patients developed intraventricular extension after sICH, among which, involvement consists of lateral ventricles of 39 patients with a percentage of 81.3%, the third ventricle of 3 patients(6.2%),the forth ventricle of 6 patients(12.5%). The average IVH volume is around 5.5ml, and mean mGraeb score about 8.5. With the baseline of similar NIHSS on admission (p=0.050) and discharge(p=0.305),patients with IVH stayed in hospital for longer days(15 vs 12 days, p=0.032),with smaller degree of NIHSS improvement (1 vs 2, p=0.018) and slower NIHSS change(0.077 vs 0.167,p=0.010). We found on the first day of admission patients with IVH with higher body temperature (37.4±0.5 vs 37.1±0.5℃, p=0.020),more elevated white blood cell(WBC) count (9.45 vs 7.95×10∧9/L,p=0.021),higher fibrinogen(3.62 vs 3.19 g/L, p=0.046),more increased blood glucose (6.92 vs 5.91 mmol/L, p=0.001),higher lactate dehydrogenase(LDH) (238.0 vs 207.0 U/L, p=0.004), CRP (8.90 vs 4.70 mg/L, p=0.049) and lower FT3 (3.18 vs 3.46 pmol/L, p=0.046). Body temperature (OR=3.44 (1.26-9.36), p=0.016) is independently associated with occurrence of IVH. For the patients with IVH after sICH, the random glucose level on admission is positively connected with the length of stay in hospital (R=0.474,p=0.001). The symptomatic improvement speed (according to NIHSS) is negatively relevant to IVH volume estimated by IVH score (R=-0.330, p=0.022).Conclusions1.The improvement of the manifestation of patient with intraventricular extention after sICH is slower, compared with sICH without IVH, demanding longer days of hospitalization.2.Ventricular extension causes higher CRP, WBC count, body temperature, blood glucose, fibrinogen and LDH on the first day of admission. Among those factors, body temperature on admission is independently relevant to the occurrence of secondary IVH.3.For the patients suffering IVH after ICH, the random blood sugar concentration on admission is positively associated with future hospital stays. Furthermore, the symptom improvement speed may be negatively affected by the ventricular blood accumulation (as mGraeb score) led by IVH.