This study hypothesizes that elevated cerebral middle artery blood flow parameters (systolic peak velocity Vs, end-diastolic velocity Vd, and mean velocity Vm) detected by transcranial Doppler ultrasound (TCD) can predict postoperative intracranial infections in hypertensive intracerebral hemorrhage patients. The primary objective is to validate TCD's predictive value for postoperative intracranial infections, with secondary objectives including analyzing the distribution characteristics of pathogenic bacteria and factors influencing infection. This retrospective cohort study enrolled 127 HICH patients who underwent surgery between April 2021 and March 2024. The participants were stratified into the infection (n = 26) and noninfection groups. TCD was used to measure peak systolic velocity (Vs), end-diastolic velocity (Vd), and mean velocity (Vm) in the bilateral middle cerebral arteries. Cerebrospinal fluid cultures were performed to identify pathogens. Multivariate logistic regression was used to identify risk factors for infection, and receiver operating characteristic (ROC) curves were used to assess the predictive performance of TCD parameters. This study identified postoperative intracranial infections in 20.47% (26/127) of HICH patients. Multivariate analysis revealed that a preoperative Glasgow Coma Scale (GCS) score > 8 (OR 0.096, P = 0.003) was a protective factor against postoperative intracranial infections, while a drainage duration ≥ 3 days (OR 5.454, P = 0.048) and elevated TCD hemodynamic parameters, including peak systolic velocity (Vs: OR 1.027, P = 0.013), end-diastolic velocity (Vd: OR 1.037, P = 0.011), and mean velocity (Vm: OR 1.045, P = 0.006), were independent risk factors for postoperative intracranial infections. ROC analysis demonstrated superior predictive accuracy for the combined TCD parameters (AUC = 0.901, sensitivity = 84.6%, specificity = 88.1%). Pathogen profiling revealed a gram-positive predominance (64.71%), primarily Staphylococcus aureus (29.41%), followed by gram-negative Acinetobacter baumannii (17.65%). The study concluded that transcranial Doppler ultrasound (particularly the combined detection of Vs, Vd, and Vm) demonstrates high efficacy in predicting postoperative intracranial infections in hypertensive intracerebral hemorrhage patients. However, changes in cerebral blood flow velocity are not specific to intracranial infections, necessitating comprehensive clinical evaluation. Additionally, Gram-positive bacteria (with Staphylococcus aureus being the most common) dominate the causative pathogens, allowing guidance for initial empirical antibiotic therapy based on their distribution patterns.
Keywords: Causative agent; Cerebrospinal fluid; Hypertensive cerebral hemorrhage; Intracranial infection; Transcranial doppler ultrasound.
© 2025. The Author(s).