Risk Factors Of Hematoma Enlargement In Spontaneous Intracerebral Hemorrhage At Acute Stage

Objective: To investigate the risk factors of hematoma enlargement in spontaneous intracerebral hemorrhage(ICH) at acute stage.We hypothesized that irregular hematoma shape、density heterogeneity and SBP were independent risk factors in hematoma enlargement.This study has provided a important clinical reference data of patients for clinical evaluation and prognosis and individualized diagnosis and treatment of spontaneous intracerebral hemorrhage.Methods: We reviewed the clinical records of 97 patients with spontaneous intracerebral hemorrhage treated non surgically. CT scans with a 5-mm-thick slice were obtained at admission within 6 hours of onset by 16-slice spiral CT. The longest diameter on the perpendicular line of the hematoma was calculated in the slice with the largest area of ICH. The shape and Hounsfield unit density of the hematoma was estimated by 5-PCS, The volume of intraventricular hematoma was excluded for this study and Completed by a senior doctor. The most irregular shape and most heterogeneous density was Ⅴgrade according to the standard. Shape CategoriesⅠto Ⅱwere labeled“regular”and Categories to Ⅲ Ⅴ“irregular” Density CategoriesⅠtoⅡwere labeled“homogeneous”and Categories Ⅲto Ⅴ“heterogeneous”. The hematoma in spontaneous intracerebral hemorrhage was estimated by ABC/2 Coniglobus formula. For descriptive purposes, baseline volumes were divided into labeled “small”was 0 to 10 m L, “medium” was 10 to 25 m L, and “large” was 25 to 106 m L.ICH growth between baseline and 48-hour CT scan,was prespecified to be examined continuouslyand using a growth definitions:(1) any ICH growth;(2)≥33% or ≥12.5 m L ICH growth; and(3) radial growth >1 mm(the median radial expansion for the data set). Gender, age, blood pressure, Glasgow coma score(GCS), past medical history, smoking history, drinking history, anticoagulation history were obtained at admission of patients. Smoking history was defined as 20 cigarettes per day and smoked for twenty years,drinking history was defined as 40 g per day and for 5 years or have episodes of binge drinking in 2 weeks. Analyses were performed using SPSS Version 17.0 software(SPSS Inc, Chicago, Ill) A probability P value < 0.05 was considered statistically significant.All risk factors were analyzed using logistic regression analysis.t-tests were used to compare differences in measurement data calculations and Count data were analyzed by χ2 test.Results: The results of this study show that by 5-point categorical scales: regular ICHs accounted for 49.48% and irregular ICHs accounted for 50.52%.homogeneous ICHs accounted for 63.92% and heterogeneous ICHs accounted for 36.08%.Furthermore,27(27.84%) out of 98 patients(hematoma with growth group) have a further expanding hematoma in this study, and 70(72.16%)out of 98 patients(hematoma without growth group) haven’t a hematoma growth.hematoma growth group was significantly higher ratio compared with hematoma without growth group in the age,ICH volume, 3 hours SBP after admission and admission SBP and history of hypertension, history of diabetes, history of long-term anticoagulant therapy,smoking history, homogeneous/irregularly ICHs, and significantly lower in GCS( P<0.05~0.01).All risk factors were analyzed using logistic regression analysis,heterogeneous hematoma and 3 hours SBP(SBP>140 mm Hg) after admission(OR=47.377,95%CI:7.827~286.789,P<0.001;OR=20.969,95%CI:3.826~114.923,P<0.001)were independent risk factors in hematoma enlargement.Conclusions:1、hematoma growth group was significantly higher ratio compared with hematoma without growth group in the age,ICH volume, 3 hours SBP after admission and admission SBP and history of hypertension, history of diabetes, history of long-term anticoagulant therapy,smoking history, homogeneous/irregularly ICHs, and significantly lower in GCS(P<0.05~0.01)2 、 Heterogeneous hematoma and 3 hours still high SBP after admission were independent risk factors in hematoma enlargement.