Clinical Characteristics And Prognosis Of Intracranial Hemorrhage In Acute Leukemia

Objective:The purpose of this study was to investigate the clinical characteristics and risk factors of intracranial hemorrhage in acute leukemia,and to analyze the prognosis and influencing factors of patients with intracranial hemorrhage in acute leukemia.Methods:3751 patients with acute leukemia aged≥14 years diagnosed by WHO classification criteria in my hospital from January 1,2010 to June 30,2020 were analyzed retrospectively.According to the presence or absence of intracranial hemorrhage,the patients were divided into two groups:intracranial hemorrhage(ICH)group and non-intracranial hemorrhage(NICH)group.Among them,there were 140 cases in ICH group.According to the sequence and serial number of patients’medical records,140cases of NICH group were selected by random sampling,and the demographic data and clinical characteristics of the two groups were compared.We included the meaningful variables in univariate Logistics regression analysis into the multivariate Logistics regression analysis model to explore the related risk factors of AL patients complicated with ICH.The effect of ICH on the prognosis of patients with AL was evaluated by Kaplan-Meier method.In the ICH group,Kaplan-Meier method and Cox proportional hazard regression model were used to analyze the prognosis,and the independent prognostic factors of AL patients complicated with ICH were obtained.Meanwhile,According to the diagnosis of APL,we selected 41 cases of APL subgroup and 239cases of non-APL subgroup to study the risk factors and prognostic factors of intracranial hemorrhage.Results:1.Analysis of risk factors of intracranial hemorrhage in acute leukemia:risk factors were analyzed by comparing ICH group with NICH group,the results of multivariate Logistics analysis showed that APL(OR:3.508,95%CI:1.468-8.385,P=0.005),LDH>245 IU/L(OR:2.730,95%CI:1.194-6.245,P=0.017),WBC>100×10~9/L(OR:6.019,95%CI:2.425-14.939,P<0.001),20×10~9/L≤PLT<50×10~9/L(OR:3.241,95%CI:1.385-7.581,P=0.007),PLT<20×10~9/L(OR:10.232,95%CI:4.471-23.417,P<0.001),PT>18s(OR:9.737,95%CI:3.388-27.980,P<0.001)were independent risk factors for intracranial hemorrhage in acute leukemia.2.Survival analysis of ICH group and NICH group:the median overall survival(OS)of ICH group was 1.0(0-2.2)months,and the median OS of NICH group was 38.0(28.2-47.8)months.The median OS of ICH group was shorter than that of NICH group,and there was significant difference between the two groups(P<0.001).3.Prognostic analysis in ICH group:The results of Cox proportional hazard regression showed that the poor prognosis of intracranial hemorrhage in acute leukemia was significantly correlated with PT>18s(HR:1.938,95%CI:1.291-2.911,P=0.001),there was significant statistical significance(P<0.05).4.APL subgroup:the results of multivariate Logistics analysis showed that coagulation disorders(OR:6.358,95%CI:1.046-38.629,P=0.045)was an independent risk factor for ICH in APL patients.5.Non-APL subgroup:the results of multivariate Logistics analysis showed that WBC>100×10~9/L(OR:7.552,95%CI:3.059-18.647,P<0.001),20×10~9/L≤PLT<50×10~9/L(OR:2.877,95%CI:1.195-6.928,P=0.018),PLT<20×10~9/L(OR:11.769,95%CI:5.097-27.173,P<0.001),PT>18s(OR:12.282,95%CI:3.991-36.579,P<0.001)were independent risk factors for ICH in non-APL patients.The results of Cox proportional hazard regression model showed that the prognosis of ICH in non-APL patients was closely related to FIB>4g/L(HR:0.499,95%CI:0.316-0.789,P=0.003),which was a favorable factor for ICH prognosis in non-APL patients.Conclusion:1.APL,PLT<50×10~9/L,WBC>100×10~9IU/L,LDH>245 IU/L and PT>18s were independent risk factors for patients with ICH.2.The median overall survival of ICH group was only 1.0(0-2.2)month,and that of NICH group was 38.0(28.2-47.8)months.The median OS of ICH group was shorter than that of NICH group.3.The poor prognosis of intracranial hemorrhage in acute leukemia is closely related to PT>18s.4.Coagulation disorders was the independent risk factor of ICH in patients with APL.5.WBC>100×10~9/L、PLT<50×10~9/L、PT>18s were independent risk factors for ICH in non-APL patients,while FIB>4g/L was favorable prognostic factors for ICH in non-APL patients.