Correlation Between The Total Burden Of Cerebral Small Vessel Disease And The Prognosis Of Neurological Function In Patients With Primary Intracerebral Hemorrhage

Objective:To evaluate the severity of the total cerebral small vessel disease(CSVD)burden in patients with primary intracerebral hemorrhage(PICH)and explore the correlation between the total burden of CSVD and the prognosis of neurological function in patients with PICH.In order to provide theoretical basis for evaluating the prognosis and scientific and systematic diagnosis and treatment of of PICH.Methods: A total of 174 PICH patients were enrolled in this study in the Department of Emergency and Neurology,Gaomi People's Hospital from June,2017 to November,2019.The first brain CT was completed in all patients within 12 hours from ictus,and a review within 24~48 hours.The brain MRI and MRA were completed within 14 days from ictus.The CSVD imaging results of the patients were evaluated according to the scale of total score of CSVD.Patients were measured on the day of hospitalization using the Glasgow Coma Scale(GCS)to assess the level of consciousness and the National Institutes of Health Stroke Scale(NIHSS)was used to measure neurological deficit.The prognosis of neurological function was measured using the modified Rankin sale(m RS)an 90 days after disease onset.The association between CSVD total burden and prognosis of neurological function was explored by spearman rank correlation analysis,multivariate logistic regression analysis and ordinal regression analysis methods.Results: Among the 174 patients,79 were enrolled in the CSVD0-1 group accounting for45.40% and 95 in the CSVD2-4 group accounting for 54.60%.Statistical analysis was performed on the general data of the two groups of patients.The results showed that there were significant differences in the proportion of hypertension,age,hematoma volume,GCS score on hospitalization,NIHSS score on hospitalization and 90 days after stroke(P<0.05);The NIHSS score on hospitalization was positively correlated to the total CSVD burden(r=0.306,P=0.000).Multivariate logistic regression analysis showed that CMBs burden(OR=0.442,95%CI =0.202~0.965,P=0.041),larger hematoma volume(OR=1.089,95%CI=1.029~1.154,P=0.003),NIHSS score on admission(OR=1.288,95%CI=1.038~1.598,P=0.021)and higher CSVD score(OR=0.271,95%CI=0.087~0.839,P=0.024)were the independent risk factors for the outcomes in PICH patients.Using ordered regression analysis to adjustment for hematoma volume,GCS score and other factors,the result showed that the total CSVD burden was an independent risk factor for prognosis of neurological function in PICH patients at 90 days(OR=3.787,95%CI=0.041~0.683;P=0.027);Further,we performed analysis by PICH location(lobar vs deep).The results showed that the total CSVD burden remains independently associated with the clinical prognosis of patients with deep ICH(OR=0.506,95%CI=0.241~0.932;P=0.038);However,in lobar ICH group age(OR=1.070,95%CI=1.032~1.309;P=0.000)and NIHSS score on admission(OR=2.072,95%CI=1.683~2.464;P=0.047)were independent risk factors for clinical outcome.Hematoma volume was significantly associated with clinical outcomes in both groups(OR=0.903,95%CI=0.820~0.981,P=0.010;OR=0.943,95%CI=0.842~0.961,P=0.001).The area under the ROC curve(AUC)of the two groups was 0.832vs0.637.As a result the sensitivity of the total CSVD burden scores to predict the outcomes of deep ICH group was better than lobar ICH group.Conclusions: The total CSVD burden is closely related to the prognosis of neurological function in PICH patients.With the increase of the total CSVD scores,the degree of neurological deficit in PICH patients was aggravated,and the function recovery is worse after 90 days of onset.The total CSVD burden is an independent risk factor for poor prognosis in PICH patients,especially it's more sensitive to predict the outcome in patients with hypertensive intracerebral hemorrhage.