Analysis Of Prognosis And Influencing Factors In Patients With Intracerebral Hemorrhage

ObjectiveTo study the short-term prognosis of patients with spontaneous intracerebral hemorrhage,and to explore the correlation between the characteristics of blood biochemical index at admission and the short-term adverse prognosis of patients,so as to provide reference for clinical treatment and early prognosis intervention.MethodsIn this study,patients with spontaneous intracerebral hemorrhage admitted to a Three-A hospital in Wuhan(Onset time < 6 hours),Hubei Province from January 2012 to December 2017 were selected as research subjects.The demographic information,physical examination,blood biochemical examination and other indicators of patients were collected by the electronic medical record information system.At the same time,the modified version of Rankin scale(mRS)was used to evaluate the recovery of neurological function in patients with intracerebral hemorrhage 3 months after discharge,and the scores were divided into good prognosis group(mRS<2)and poor prognosis group(mRS?2).Univariate analysis was used to analyze the prognostic indicators of patients in the two groups,multi-factor unconditional logistic regression analysis was performed on the indicators with significant differences,so as to explore the risk factors affecting the prognosis of patients with spontaneous intracerebral hemorrhage.Logistic regression model was used to draw the ROC curve for predicting the prognosis or outcome of patients with intracerebral hemorrhage.Meanwhile,a restrictive cubic spline model was used to investigate the dose-response relationship of correlation strength between systolic blood pressure,National Institutes of Health Stroke Scale(NIHSS)score,high-sensitivity C-reactive protein,homocysteine,neutrophils and adverse prognosis in patients with spontaneous intracerebral hemorrhage.A decision tree model was constructed to obtain the degree of influence of different factors on the prognosis of patients with intracerebral hemorrhage.ResultsA total of 402 subjects were included,including 266 males and 136 females.There were 244 patients with poor prognosis,accounting for 60.7% of the total.The prediction accuracy of this model was 80%,and the standard deviation of 0.026.Multivariate logistic regression showed age [OR=1.03,95% CI(1.00~1.05),P=0.04],NIHSS score [OR=1.13,95%CI(1.08~1.18),P<0.01],high-density lipoprotein [OR=11.93,95% CI(2.10~67.6),P=0.01],high-sensitivity cardiac troponin [OR=1.01,95% CI(1.01~1.02),P<0.01],glutamic-oxalacetic transaminase [OR=0.97,95% CI(0.94~0.99),P=0.03],high-sensitivity C-reactive protein [OR=1.03,95%CI(1.01~1.06),P=0.01] and systolic blood pressure level [OR=1.01,95% CI(1.00~1.03),P=0.07] were the influencing factors of adverse outcomes.The area under the curve(AUC)was 0.86.The restrictive cubic spline model showed that the risk of poor prognosis increased with the rise of NIHSS score,systolic blood pressure,and high-sensitivity C-reactive protein.The decision tree model showed that NIHSS score,high-sensitivity C-reactive protein level,high-sensitivity cardiac troponin level,high-density lipoprotein level,low-density lipoprotein level,neutrophil level and other indicators had a great influence on poor prognosis of patients with intracerebral hemorrhage in turn.ConclusionsThe results of this study showed that the prognosis of patients with spontaneous intracerebral hemorrhage was poor 3 months after discharge,and the occurrence of adverse prognosis was more common.Admission clinical indications and complications such as age,NIHSS score,high-sensitivity C-reactive protein levels,high-sensitivity cardiac troponin levels,high-density lipoprotein levels,low-density lipoprotein levels,neutrophil levels,glutamic-oxalacetic transaminase levels and systolic blood pressure were found independently related to poor prognosis of patients with spontaneous intracerebral hemorrhage.Meanwhile,the risk of poor prognosis was significantly increased with NIHSS score(>4),systolic blood pressure(>130mmHg),and high-sensitivity C-reactive protein(>7.5mg/L).The above indicators have important value for medical workers to evaluate the short-term prognosis of patients with spontaneous intracerebral hemorrhage,take reasonable treatment and intervention measures in time,and finally improve the prognosis of patients.