Effect Of Leukoaraiosis On The Prognosis In Patients With Spontaneous Supratentorial Intracerebral Hemorrhage

Objective To explore the influencing factors on the prognosis of spontaneousintracerebral hemorrhage and to investigate the relationship between leukoaraiosis (LA)and prognosis of intracerebral hemorrhage (ICH), so as to provide the scientificevidence on the assessment of prognosis.Methods The patients with spontaneous supratentorial intracerebral hemorrhage indepartment of Neurology of the Affiliated Hefei Hospital of Anhui Medical Universityfrom August2010to March2011were registered. We assessed LA severity by VanSwieten score (VSS) on brain CT at admission and the clinical data of them werecollected routinely. Patients were divided into two groups according to prognosis at90days by Glasgow Outcome Scale (GOS): patients with good prognosis (GOS≥4) andpatients with poor prognosis (GOS＜4). Demographic features, hematomacharacteristics, and LA severity were compared between the two groups by usingunivariate analysis. Then multivariate analysis the statistically significant and possibleclinical significance factors to judge whether LA is a risk factor of prognosis afterspontaneous supratentorial ICH.Results1. A total of139patients with spontaneous supratentorial ICH were enrolledduring the study period. We excluded a total of21patients because of motion artifact onCT that prevented determination of LA severity (3patients) or incomplete informationregarding patient prognosis (18patients). The remaining118patients comprised the final study population,71cases were males (62.21％),47cases were females. The agerange of the cases was from31to95years old. The mean age of the cases was (67.5±13.5) years. There were60(50.8%) of the patients analyzed had poor prognosis and38(32.2%) cases were dead. The mean scores of LA with poor prognosis was2.3±1.5while those of good prognosis was1.1±1.1, and showed statistically significantdifference (P＜0.001).2. Univariate analysis showed the following seven factors were possibly associated withpoor prognosis: age, systolic blood pressure (SBP), serum glucose level at admission,LA scores, hematoma volume, intraventricular hemorrhage (IVH) and initial GlasgowComa Scale (GCS) scores. However, gender, history of hypertension and diabetesmellitus (DM), smoking status, diastolic blood pressure (DBP) and heart rate (HR) didnot differ between the two groups. Hematoma location (lobar vs. deep) was notassociated with neurological outcome. The multi-factor logistic regression analysisshowed that severity of LA (OR=5.390,95%CI1.417–20.503, P＜0.01), initial GCSscore (OR=23.730,95%CI4.923–114.371, P＜0.01), hematoma volume (OR=1.202,95%CI1.079–1.338, P＜0.01), and presence of IVH (OR=6.079,95%CI1.035–35.712,P＜0.05) were independent predictors of poor prognosis.Conclusion Multiple logistic regression analysis indicated that the severity of LA,GCS score, hematoma volume and presence of IVH were independent predictors ofpoor prognosis in patients with spontaneous supratentorial intracerebral hemorrhage.Overall, this report suggests that LA should be taken into account when consideringprognosis in ICH patients.