Predictive Value Of Biochemical Indexes Combined With CT Signs For Early Hematoma Enlargement In Spontaneous Intracerebral Hemorrhage

Objective:To explore the predictive value of biochemical indexes combined with non-contrast CT(NCCT)for early hematoma enlargement(HE)in spontaneous intracerebral hemorrhage(ICH).Methods:The clinical data of 146 patients with ICH in our hospital from January 2021 to December 2021 were retrospectively analyzed.According to the occurrence of HE,the patients were divided into HE group and non-HE group.According to the 30-day self-care situation,the patients were divided into good prognosis group and poor prognosis group.The incidence of HE was calculated.The Sociology-morbidity factors were compared between the HE group and the non-HE group.ROC curve was drawn to analyze the predictive impact of each indicator on early HE.Spearman correlation coefficient was used to analyze the correlations between serum Calcium,high-sensitivity C-reactive protein(hs-CRP),blood glucose levels,NCCT signs and the incidence of early HE.The differences of serum Calcium,hs-CRP and blood glucose levels between the good prognosis group and the poor prognosis group were compared.The effects of serum Calcium,hs-CRP and blood glucose levels on early HE in patients with ICH were analyzed by multivariate analysis,and the clinical predictive efficacy of the prognosis of patients with ICH by serum Calcium,hs-CRP,blood glucose indexes was analyzed.The Nomogram was established to predict the probability of HE occurrence in ICH patients and was calibrated and verified internally.Results:Compared with the baseline hematoma volume,the hematoma volume was significantly increased by NCCT review in HE group,and the incidence of HE was 10.96%.According to statistical analysis,hypertension,diabetes,thalamus,basal ganglia,baseline hematoma volume,systolic blood pressure(SBP),blood glucose(GLU)and blend sign were independent risk factors for HE of the ICH patients(P<0.05),plasma fibrinogen(FbgC)and serum Calcium(Ca2+)were independent protective factors(P<0.05).The AUC of serum Calcium,blood glucose,plasma fibrinogen,systolic blood pressure and blend sign were all higher than 0.62,and the sensitivity and specificity were all greater than 50.00%.HE incidence of ICH was positively correlated with hs-CRP and GLU,and negatively correlated with Ca2+.Compared with the non-HE group,the proportion of blend sign in the HE group was significantly higher and was an independent risk factor for HE in ICH patients(P<0.05).The sensitivity,specificity and AUC of biochemical indexes combined with NCCT signs were higher than those of single diagnosis,with sensitivity and specificity of 98.10%and 98.40%,respectively,and AUC of 0.959.Ca2+was significantly decreased in the poor prognosis group compared with the good prognosis group(P<0.05).The Nomogram was established with five indexes including Ca2+,GLU,FbgC,SBP and blend sign.The calibration curve of the model showed that the prediction probability of hematoma enlargement of the model could well fit the actual probability,and the calibration degree was high.DCA was used to evaluate the clinical practicability of the model,showing that most of the prediction model was far away from the two extreme curves.When the probability range of its domain was 3%-97%,the benefit was higher,and the probability range of the optional domain was larger,indicating that the model had strong clinical practicability.Internal verification results showed that the C-index of the model to predict the expansion of hematoma was 0.966,and the differentiation was good.Conclusion:ICH patients with HE may have abnormal increased GLU and decreased Ca2+.Blend sign suggested that the probability of PIE was higher in ICH patients.Hypertension,diabetes,thalamus,basal ganglia,baseline hematoma volume,SBP,GLU and blend sign were all independent risk factors for the HE occurrence of ICH,while FbgC and Ca2+were independent protective factors,providing a basis for clinical management of relevant indicators.The Nomogram model established in this study had good efficacy in predicting the HE occurrence of in ICH patients,with large domain probability coverage and good differentiation.Combined application of multiple indicators can improve the overall prediction efficiency and has the value of clinical application.