| Objective:To investigate the risk factors of aneurysmal subarachnoid hemorrhage(aSAH)with intracranial hematoma(ICH)and to analyze the prognostic factors of aSAH with ICH.Methods:The clinical data of aSAH patients admitted to the first affiliated Hospital of Guangxi Medical University from January 2012 to June 2019 were retrospectively analyzed.According to the presence or absence of intracranial hematoma,the subjects were divided into ICH group and non-ICH group.Collect relevant clinical information of the two groups of patients,including general conditions(sex,age,admission systolic and diastolic blood pressure,smoking history,drinking history,hypertension history,diabetes history),imaging examination(hematoma volume,intraventricular hemorrhage,hydrocephalus,pulmonary infection)and characteristics related to responsible aneurysms(parent artery,aneurysm shape,maximum aneurysm diameter,neck width,etc.),Two groups of baseline data were analyzed to explore the risk factors for predicting aSAH complicated with ICH.According to the GOS score of discharged patients,the ICH group was divided into good prognosis group and poor prognosis group,to explore the related factors affecting the short-term prognosis of aSAH complicated with ICH,and the predictive value of hematoma volume on the prognosis of aSAH complicated with ICH was analyzed by receiver working characteristic curve(ROC).Result:A total of 736 aSAH patients were included in this study.There were659 patients(89.5%)in the non-ICH group and 77 patients(10.5%)in the ICH group.In the ICH group,the maximum hematoma volume was 60 ml,the minimum hematoma volume was 4 ml,and the average hematoma volume was18.38 ± 15.6 ml.Compared with the non-ICH group,the patients in the ICH group were relatively young(52.42 ± 11.40 vs 55.22 ± 10.81,p<0.05).There were 275 males(41.7%)and 384 females(58.3%)in the non-ICH group;29males(37.7%)and 48 females(62.3%)in the ICH group.In terms of underlying diseases,the prevalence of diabetes in the ICH-free group was higher than that in the ICH group(4.85% vs 2.59%,p<0.05),the difference between the two groups was statistically significant;the difference between the two groups of hypertension and heart disease was not statistically significant.There was no significant difference in smoking history and drinking history between the two groups.In terms of clinical manifestations,14 patients(18.2%)had sentinel headaches in the ICH group,42 patients(54.5%)had unconsciousness,6patients(7.8%)had seizures,and 101 patients(15.2%)had sentinel headaches in the non-ICH group),There were 242 cases of consciousness disorder(36.7%)and 35 cases of seizures(5.3%);the difference between the two groups in the occurrence of consciousness disturbance was statistically significant(p<0.05),and there was no statistical difference in sentinel headache and seizures significance.In addition,there was no statistically significant difference in systolic blood pressure,diastolic blood pressure,and blood glucose between the two groups.In terms of complications,hydrocephalus occurred in 12 cases(15.6%),intraventricular hemorrhage in 31 cases(49.26%),pulmonary infection in 40 cases(51.9%),and rebleeding in 23 cases(29.87%)in the ICH group.In the non-ICH group,hydrocephalus occurred in 104 cases(15.8%),intraventricular hemorrhage in 137 cases(20.79%),pulmonary infection in 258cases(39.2%),and rebleeding in 66 cases(10.01%).The incidence of intraventricular hemorrhage and rebleeding in ICH group was significantly higher than that in non-ICH group,but there was no significant difference in hydrocephalus and pulmonary infection between the two groups.In terms of characteristics of responsible aneurysms,patients in the ICH group and the non-ICH group had significant differences in aneurysm locations and daughter sacs.The proportion of internal carotid aneurysms in the non-ICH group was higher than that in the ICH group(44.3% vs 23.4%,p=0.01),in the ICH group,the proportion of responsible aneurysms located in the middle cerebral artery was significantly higher than that in the non-ICH group(36.4% vs 16.1%,p<0.001);in addition,the difference in the daughter sacs between the two groups of responsible aneurysms was also statistically significant.The proportion of daughter sacs in the ICH group was higher than that in the non-ICH group(50.6% vs 35.1%,p=0.02).However,there was no statistically significant difference between the two groups in terms of whether the aneurysm was regular(p=0.293),whether there was multiple aneurysm(p=0.806),the size of the aneurysm(p=0.594),and the neck width(p=0.701).Multivariate logistic regression analysis of the above variables with significant differences showed that the responsible aneurysm was located in the middle cerebral artery(OR=2.205,95%CI=1.240-3.921,p=0.007)and the presence of Daughter sacs(OR=1.850,95%CI=1.132-3.025,p=0.014)may be a risk factor for aSAH complicated with ICH.The ICH group was divided into two groups according to the GOS score at discharge.The GOS 4-5 score was defined as a good prognosis group(39 cases,50.6%),and the GOS 1-3 score was defined as a poor prognosis group(38 cases,49.4%).There were 38 patients with poor prognosis,including 23 deaths(60.5%).Univariate analysis showed that the age of the good prognosis group was significantly lower than that of the poor prognosis group(49.67 ± 10.88 vs56.8 ± 9.73,p=0.003).There were no statistical differences in gender,previous basic disease history,smoking history,and drinking history.In terms of clinical manifestations,hematoma volume(25.88±17.93 vs 11.07±7.95,p<0.001),rebleeding rate(44.7%vs 20.5%,p=0.023),and unconsciousness(76.9%vs34.2%,p<0.001),intraventricular hemorrhage(57.9% vs 25.6%,p=0.04)in poor prognosis group was significantly higher than the good prognosis group;The number of patients with HUNT-HESS grade Ⅰ-Ⅲ in the good prognosis group was 22(56.4%),11(28.2%),6(15.4%)and 0 in the HUNT-HESS gradeⅣ-V,while the number of patients with HUNT-HESS grade Ⅰ-V in the poor prognosis group was 7(18.4%),5(13.2%),5(13.2%),11(28.9%)and 10(26.3%),the difference between the two groups was statistically significant(<0.001),HUNT-HESS grade was higher in the poor prognosis group.Of the 58 patients treated with surgery,23 had a poor prognosis,9 of which died(15.5%),and the proportion of poor prognosis was 79.7%;16 of the 19 conservative treatment patients had a poor prognosis,14 of which died(73.7%),and the poor prognosis proportion was 84.2%.The poor prognosis and mortality rate in the conservative treatment group were higher than those in the surgical treatment group,and there were significant differences between the two groups(p < 0.05).Logistic regression analysis was conducted on the above factors with statistical differences.The results showed that the admission HUNT-HESS grade,hematoma volume and conservative treatment were the risk factors affecting the prognosis aSAH complicated with ICH.Incorporating the hematoma volume and prognosis into the ROC curve analysis showed that the area under the curve of the prognosis of the hematoma volume of aSAH patients with ICH was 0.768(95% CI: 0.551-0.858),and the best cutoff value was 10.3ml,with a sensitivity of 0.711 and a specificity of 0.718.Conclusion:Daughter sacs and middle cerebral artery aneurysms are risk factors for aSAH with ICH,which should be noted when evaluating the surgical risk of unruptured aneurysms.Admission HUNT-HESS grade,conservative treatment and hematoma volume can predict the prognosis of patients with aSAH complicated with ICH.The higher the HUNT-HESS grade,the worse the prognosis.Active surgical treatment can improve the prognosis.Hematoma volume greater than 10.3ml indicates a poor prognosis. |
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