| Objective:spontaneous intracerebral hemorrhage(ICH)is a severe cerebrovascular disease with high mortality and disability,which brings heavy burden to patients’ families,society and country.Intracerebral hemorrhage occurring in 18-50 years old is usually called youth intrcerebral hemorrhage.The sequelae of hemiplegia and aphasia caused by youth cerebral hemorrhage will cause more heavy burden to individual,family and society.At present,there is no study on the epidemiological characteristics of cerebral hemorrhage in young people in Hubei Province.Lack of large sample size of epidemiological survey data.The purpose of this study was to conduct a cross-sectional survey on the epidemiological characteristics of cerebral hemorrhage among young people in Hubei Province in February 2022,this study made up the blank of the epidemiological data of the young patients with intracerebral hemorrhage in Hubei povince of our country and established a new and valuable nomogram model including hemoglobin to predict the prognosis of the young patients with intracerebral hemorrhage in 6 months.Methods:420,000 permanent residents in Hubei Province were selected by multi-stage stratified random cluster sampling.A cross-sectional survey was conducted in February 2022 to calculate the incidence and mortality of ICH and ICH in young 2021 from 2018 to 2022.Basic demographic information,onset month and season,family history of ICH,hospitalization,and current survival were collected.The patients were divided into two groups according to their ages:the young group and the old group.The differences in sex,onset month,family history and hospitalization between the two groups were compared.In order to explore the risk factors of young patients with cerebral hemorrhage,1:1 healthy matching of the same sex and age was carried out.The young patients with cerebral hemorrhage were divided into good prognosis group and bad prognosis group,heavy dependence group and non-heavy dependence group,Death Group and survival group,to explore the risk factors of poor prognosis,severe dependence and death in young patients with cerebral hemorrhage.Patients aged 18 to 50 years with cerebral hemorrhage were Tongji Medical College from January 2012 to December 2018 in Tongji Hospital affiliated to Tongji Medical College.Univariate and multivariate analyses were performed to retrospectively analyze the 6-month prognostic factors of the 565 young patients.Based on the independent risk factors screened,a brand new nomogram was established and validated.The clinical value of this nomogram was evaluated using clinical decision curves and clinical impact curves.Results:This cross-sectional study screened 473229 people,Male 241522,accounting for 51.04%,female 231707,accounting for 48.96%.The average age was 41.46.Between 2018 and 2021,the incidence rate of intracerebral hemorrhage was 2.01 per 100,000 personyears and the mortality rate was 0.63 per 100,000 person-years.In the month of onset,the number of patients was the most in July,October and November,and in autumn was the most in the season of onset.Compared with the elderly patients,the young patients had more family history of ICH,and were more active in hospitalization and operation.History of hypertension was an independent risk factor of cerebral hemorrhage in youth,OR was 2.856,95%CI was 1.619-5.041.Moderate physical activity was an independent protective factor of cerebral hemorrhage in youth,OR was 0.435,the 95%CI was 0.238-0.794.There were 46 cases with poor prognosis(36.22%),28 cases with severe dependence(22.05%),23 cases with death(18.11%).Female was an independent risk factor for poor prognosis in young patients with intracerebral hemorrhage(OR=2.267,95%CI=1.055-4.871).Long sleep duration was an independent protective factor for severe cerebral hemorrhage in young patients with OR=0.597,the 95%CI was 0.413-0.862,and health education was an independent protective factor for death from intracerebral hemorrhage in young adults with an OR of 0.217,95%CI of 0.077-0.615.In the hospital population,there were 565 young patients with cerebral hemorrhage,117 patients(20.7%)had poor prognosis after 6 months,the subtentorial region(adjusted odds ratio[AOR-RSB-=3.708,95%confidence interval[CI],1.490-9.2P7;P=0.005)was the most significant risk factor.Age([AOR]=1.054;95%CI,1.014-1.096;P=0.008),hematoma volume(AOR=1.014,95%CI,1.002-1.027;P=0.024),and blood glucose(AOR=1.135,95%CI,1.037-1.241;P=0.005)and NIHSS(AOR=1.105,95%CI,1.069-1.141;P<0.001)were independent risk factors,hemoglobin(AOR=0.981,95%CI,0.969-0.993;P=0.002)was an independent protective factor.Based on these six factors,we built a trusted tool for nomograms.It was associated with an increased probability of poor outcome in young patients after 6 months of ich(c-index=0.791).The clinical decision curve and the clinical impact curve also showed an increased net benefit from the use of this nomogram.Conclusions:The morbidity and mortality of intrcerebral hemorrhage in young people in Hubei province are similar to those of foreign studies.In Hubei province,there are many cases of intracerebral hemorrhage in young people in autumn,and the family history of intracerebral hemorrhage is more,which provides data support for scientific decisionmaking of intervention measures of local intracerebral hemorrhage.Hypertension and moderate physical activity are closely related to the onset of intracerebral hemorrhage in young people.For young people,active control of blood pressure and appropriate physical activity exercise on the occurrence of intracerebral hemorrhage plays an important role in prevention.Female,long sleep duration and health education are closely related to the prognosis of young patients with intracerebral hemorrhage.It is suggested that it is necessary to have healthy sleeping habits and individualized and feedback education activities in young people with intracerebral hemorrhage.Haemoglobin at admission may be an easily overlooked clinical marker.The new nomogram model may be valuable and convenient for predicting the early prognosis of intracerebral hemorrhage in young adults.At the same time,there is a need for more multicentre external justification.Part Ⅰ:Epidemiological characteristics of intracerebral hemorrhage in young adults in Hubei provinceObjective:Spontaneous intracerebral hemorrhage(ICH)is a severe cerebrovascular disease with high mortality and disability,which brings a heavy burden to the patients’ families,society and country.Intracerebral hemorrhage occurring in 18-50 years old is usually called youth intracerebral hemorrhage.The sequelae of hemiplegia and aphasia caused by youth cerebral hemorrhage will cause more heavy burden to individual,family and society.At present,there is no study on the epidemiological characteristics of intracerebral hemorrhage in young adults in Hubei province.The purpose of this study was to investigate the epidemiological characteristics of young adults with intracerebral hemorrhage in Hubei province in February 2022,and to fill the gap in the epidemiological data of young alults with intracerebral hemorrhage in Hubei province of our country.Methods:A multi-stage stratified random cluster sampling method was used to screen 420,000 permanent residents in Hubei province for intracerebral hemorrhage.A crosssectional survey was conducted in February 2022 to calculate the incidence and mortality of ICH and ICH in young from 2018 to 2021.Basic demographic information,onset month and season,family history of ICH,hospitalization and current survival were collected.The patients were divided into two groups according to their ages:the young group and the old group.The differences in sex,onset month,family history and hospitalization between the two groups were compared.Results:In this cross-sectional study,473229 persons were screened,241522 males(51.04%)and 231707 females(48.96%).The average age was 41.46.Between 2018 and 2021,the incidence rate of intracerebral hemorrhage was 2.01 per 100,000 person-years and the mortality rate was 0.63 per 100,000 person-years.In the month of onset,the number of patients was the most in July,October and November,and in autumn was the most in the season of onset.Compared with the elderly patients,the young patients had more family history of ICH,and were more active in hospitalization and operation.Conclusions:The morbidity and mortality of intracerebral hemorrhage in young adults in Hubei province are similar to those of foreign studies.In Hubei province,there are many cases of intracerebral hemorrhage in young adults in autumn,and the family history of intracerebral hemorrhage is more,which provides data support for scientific decisionmaking of intervention measures of local intracerebral hemorrhage.PartⅡ:Study on the risk factors of intracerebral hemorrhage in young adults in Hubei provinceObjective:Spontaneous intracerebral hemorrhage(ICH)is an extremely serious cerebrovascular disease with high mortality and disability rates and a heavy burden on society and families.Intracerebral hemorrhage that occurs between the ages of 18 and 50 is usually called a youth intracerebral hemorrhage.The risk factors of intracerebral hemorrhage are many and complex.Blood pressure,blood glucose,cholesterol concentration,body mass index,smoking,physical activity and diet were all associated with ICH.However,most of these risk factors have not been clearly studied in young adults with intracerebral hemorrhage.The purpose of this study was to explore the risk factors of intracerebral hemorrhage in young adults in Hubei province,and to fill the gap of systematic data on the risk factors of ich in young adults in Hubei province.Methods:The case group was 127 young patients with intracerebral hemorrhage screened out in the first part.Healthy controls were a 1:1 matched,without cerebrovascular disease,healthy group of the same sex and age at the same sampling point for each young patient with intracerebral hemorrhage screened in the first part.The data of all patients and healthy controls were collected and analyzed retrospectively,such as gender,age,height,weight,family size,ethnic group,diet,physical activity,drinking and past history.Binary logistic regression analysis was used to analyze the risk factors of cerebral hemorrhage in young adults.Results:The study involved 127 cases and 127 healthy controls.History of hypertension was an independent risk factor of cerebral hemorrhage in youth,OR was 2.856,95%CI was 1.619-5.041.Moderate physical activity was an independent protective factor of cerebral hemorrhage in youth,OR was 0.435,the 95%CI was 0.238-0.794.Conclusions:Hypertension and moderate physical activity are closely related to the onset of intracerebral hemorrhage in young adults.For young adults,active control of blood pressure and appropriate physical activity exercise on the occurrence of intracerebral hemorrhage plays an important role in prevention.Part Ⅲ:Analysis of risk factors affecting the poor prognosis of young adultss with intracerebral hemorrhage based on community populationObjective:Intracerebral hemorrhage is a disease with high mortality and disability rate.Intracerebral hemorrhage in young adults can lead to poor prognosis,impaired social and work ability,and increase the burden of disease because of its sequelae such as hemiplegia and aphasia.A variety of risk factors are associated with poor prognosis in young patients with intracerebral hemorrhage.Age,hematoma volume and stroke score were predictive factors of poor prognosis in young patients with intracerebral hemorrhage.But these predictive factors are mostly objective and unchangeable factors,and some variables are difficult to be understood by non-neurologist and used in secondary prevention of intracerebral hemorrhage.And the above risk factors in the world have not been fully unified,there is obvious controversy.The aim of this study was to analyze the multiple variables that affect the prognosis of young adults with intracerebral hemorrhage in a communitybased population.Methods:The sex,age,height,weight,family size,visits,physical activity,smoking,alcohol consumption and past history of 127 young adults with ICH were collected retrospectively.They were divided into good prognosis group and bad prognosis group according to mRS score,severe dependence group and non-severe dependence group according to BI Index score,and survival group and death group according to survival condition.Binary Logistic regression analysis was used to analyze the risk factors of poor prognosis,severe dependence and death respectively.Results:This study involved 127 young patients with intracerebral hemorrhage.The mean follow-up time was 5.74 years.46 young patients with intracerebral hemorrhage had poor prognosis,accounting for 36.22%of the total,28 patients had severe dependence,accounting for 22.05%of the total,and 23 patients had died,accounting for 18.11%of the total.Female was an independent risk factor for poor prognosis in young patients with intracerebral hemorrhage(OR=2.267,95%CI=1.055-4.871).Duration of sleep was an independent protective factor in young patients with intracerebral hemorrhage(OR=0.597,95%C1 0.413-0.862),and health education was an independent protective factor for death from intracerebral hemorrhage in young adults(OR=0.217,95%CI 0.077-0.615).Conclusions:Women,sleep duration and health education were closely related to the prognosis of young patients with intracerebral hemorrhage.It is suggested that it is necessary to have healthy sleeping habits and individualized and feedback education activities in young adults with intracerebral hemorrhage.Part Ⅳ:A 6-month prognostic nomogram for intracerebral hemorrhage in younger adults based on hospital populationObjective:Intracerebral hemorrhage(ICH)is the second most common subtype of stroke with higher mortality and morbidity,and it lacks effective 6-month prognostic markers,especially in young patients.The aim of this research is to construct a newly valuable prognostic nomogram model incorporating hemoglobin level for young patients with ICH.Methods:Patients Aged between 18 and 50 years with first-ever intracerebral hemorrhageselected from Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 1,2012 to December 31,2018.We retrospectively analyzed 565 young patients with ICH.The independent factors of prognosis were identified by univariate and multivariate logistic regression analysis.Then,based on independent risk factors,a new nomogram model was further constructed and validated.Its clinical value was subsequently explored utilizing decision curve analysis and clinical impact curve.Results:A total of 565 patients were enrolled in this study.There were 117 patients(20.7%)who developed unfavourable prognosis.Infratentorial lesion(adjusted odds r atio[aOR]=3.708,95%confidence interval[CI],1.490-9.227;P=0.005)was most signifi cant with unfavourable outcome.Age([aOR]=1.054;95%CI,1.014-1.096;P=0.008),hemat oma volume(aOR=1.014,95%CI,1.002-1.027;P=0.024),,blood glucose(aOR=1.135,95%CI,1.037-1.241;P=0.005)and NIHSS(aOR=1.105,95%CI,1.069-1.141;P<0.001)were in dependent risk factors.Hemoglobin(aOR=0.981,95%CI,0.969-0.993;P=0.002)was a in dependent protect factor.Based on these 6 factors,a reliable nomogram was construct ed for the prediction of unfavourable prognosis in our study(C-index=0.791).Decisi on curve analysis and clincal impact curve showed showed an increased net bene fit for utilizing the nomogram.Conclusions:The hemoglobin level at admission may be an easily overlooked factor in clinical work.This new nomogram model could be a promising and convient tool to predict the early functional prognosis of in young people with ICH. |
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