Analysis Of Risk Factors Of Hematoma Enlargement In Acute Stage Of Intracerebral Hemorrhage

Objective:Hematoma enlargement is not uncommon in cerebral hemorrhage,and is known to be a strong predictor of neurological deterioration and the result of dysfunction.Therefore,it has been an important hot spot in the study of cerebral hemorrhage.Up to now,more than 50 risk factors have been analyzed,and the results are divergent.The purpose of this study was to analyze the risk factors for enlargement of intracerebral hemorrhage and compare two methods of hematoma prediction scoring without CT angiography.BAT(Blend singn,Any hypodensity,Time from onset to NCCT)scoring system and 24-point prediction method to find the most suitable local prediction scoring method.Methods:A retrospective analysis was made on the patients with spontaneous cerebral hemorrhage from December 2015 to December2018 in Yueyang Two People’s Hospital.The patients were admitted within 24 hours of onset.The first CT scan was completed within 30 minutes of admission.After admission,the patients’ condition was aggravated and the cranial CT was reviewed at any time.The patients’ symptoms were assessed by the changes of Nihss score.The increase of 3points was defined as aggravation of symptoms.If the second CT reexamination is completed within 24 hours after admission withoutaggravation,the amount of bleeding is calculated by the Doda formula commonly used in domestic clinical and research.When reexamined,the volume of hematoma increases by more than 33% or 6 ml,which is defined as enlargement of hematoma.The patients are divided into enlargement of hematoma group and non-enlargement of hematoma group.The basic clinical information and CT features of the patients were collected and sorted out according to the case review system,and then BAT score was given(see Table 1 for details).The mixed score accorded with 1 point and the void sign was 2 points.The time from onset to the first CT was not more than 2.5 hours and 2 points.The total score was 5points,and the score of high risk and 24 points was greater than or equal to 3 points(see Table 2 for details).Statistical soft SPSS22.0 was used to analyze the data.Univariate analysis,screening and multivariate logistic regression analysis were used to determine the risk factors of cerebral hemorrhage hematoma enlargement.ROC curve was drawn to compare the area under the curve of the two prediction methods.Results:(1)292 cases of intracerebral hemorrhage were collected,70 cases were excluded and 222 cases were qualified.Among them,156cases(70.27%)were male,66 cases(29.73%)were female,60 cases(27.03%)were enlarged hematoma,162 cases were not enlarged.(2)the incidence of intracerebral hemorrhage was higher in men,but there was no statistical difference between the enlarged sex of hematoma after intracerebral hemorrhage.There were no significant differences in age,sex,smoking,drinking,diabetes,liver dysfunction,and systolic blood pressure between the two groups.(3)in the patients with long interval between the time point of onset and the time point of the first CT,the enlargement of hematoma was less at the second time of CT,and the enlargement of hematoma often occurred in the early stage of the courseof disease.Single-factor and multi-factor regression analysis were used to compare the irregular appearance of CT,black hole sign and mixed sign in two groups of patients,which were the risk factors of hematoma enlargement.(4)the area under the curve of BAT score was 0.769,the sensitivity was 0.53,the specificity was 0.875,the cut-off value was >2.5.At 24:00,the area under the score curve was 0.759,the sensitivity was 0.69,and the sensitivity was 0.69 under the ROC curve.The specificity was 0.71 and the cut-off value was > 7.5.Conclusion:(1)The incidence of hematoma enlargement in patients with acute cerebral hemorrhage was 27.03%.(2)The possible risk factors of enlargement of hematoma in acute stage of cerebral hemorrhage are increased systolic blood pressure,irregular shape of hematoma,black hole sign and mixed sign.(3)BAT score may be superior to 24-point score in evaluating the enlargement of intracerebral hemorrhage hematoma.