Early Deterioration and Long-Term Prognosis of Patients With Intracerebral Hemorrhage Along With Hematoma Volume More Than 20 ml: Who Needs Surgery?

Fuxin Lin; Qiu He; Youliang Tong; Mingpei Zhao; Gezhao Ye; Zhuyu Gao; Wei Huang; Lveming Cai; Fangyu Wang; Wenhua Fang; Yuanxiang Lin; Dengliang Wang; Linsun Dai; Dezhi Kang

doi:10.3389/fneur.2021.789060

Early Deterioration and Long-Term Prognosis of Patients With Intracerebral Hemorrhage Along With Hematoma Volume More Than 20 ml: Who Needs Surgery?

Front Neurol. 2022 Jan 5:12:789060. doi: 10.3389/fneur.2021.789060. eCollection 2021.

Authors

Fuxin Lin^{1

2

3}, Qiu He¹, Youliang Tong⁴, Mingpei Zhao¹, Gezhao Ye¹, Zhuyu Gao¹, Wei Huang¹, Lveming Cai¹, Fangyu Wang^{1

4}, Wenhua Fang^{1

4}, Yuanxiang Lin^{1

3}, Dengliang Wang^{1

3}, Linsun Dai^{1

3}, Dezhi Kang^{1

2

3}

Affiliations

¹ Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
² Clinical Research and Translation Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
³ Fujian Clinical Research Center for Neurological Diseases, Fuzhou, China.
⁴ Department of Neurosurgery, Wupin County Hospital, Wupin, China.

Abstract

Background and Purpose: The treatment of patients with intracerebral hemorrhage along with moderate hematoma and without cerebral hernia is controversial. This study aimed to explore risk factors and establish prediction models for early deterioration and poor prognosis. Methods: We screened patients from the prospective intracerebral hemorrhage (ICH) registration database (RIS-MIS-ICH, ClinicalTrials.gov Identifier: NCT03862729). The enrolled patients had no brain hernia at admission, with a hematoma volume of more than 20 ml. All patients were initially treated by conservative methods and followed up ≥ 1 year. A decline of Glasgow Coma Scale (GCS) more than 2 or conversion to surgery within 72 h after admission was defined as early deterioration. Modified Rankin Scale (mRS) ≥ 4 at 1 year after stroke was defined as poor prognosis. The independent risk factors of early deterioration and poor prognosis were determined by univariate and multivariate regression analysis. The prediction models were established based on the weight of the independent risk factors. The accuracy and value of models were tested by the receiver operating characteristic (ROC) curve. Results: After screening 632 patients with ICH, a total of 123 legal patients were included. According to statistical analysis, admission GCS (OR, 1.43; 95% CI, 1.18-1.74; P < 0.001) and hematoma volume (OR, 0.9; 95% CI, 0.84-0.97; P = 0.003) were the independent risk factors for early deterioration. Hematoma location (OR, 0.027; 95% CI, 0.004-0.17; P < 0.001) and hematoma volume (OR, 1.09; 95% CI, 1.03-1.15; P < 0.001) were the independent risk factors for poor prognosis, and island sign had a trend toward significance (OR, 0.5; 95% CI, 0.16-1.57; P = 0.051). The admission GCS and hematoma volume score were combined for an early deterioration prediction model with a score from 2 to 5. ROC curve showed an area under the curve (AUC) was 0.778 and cut-off point was 3.5. Combining the score of hematoma volume, island sign, and hematoma location, a long-term prognosis prediction model was established with a score from 2 to 6. ROC curve showed AUC was 0.792 and cutoff point was 4.5. Conclusions: The novel early deterioration and long-term prognosis prediction models are simple, objective, and accurate for patients with ICH along with a hematoma volume of more than 20 ml.

Keywords: early deterioration; intracerebral hemorrhage; long-term prognosis; prediction model; risk factors.