Stratification Study Of Early Disease Deterioration And Poor Prognosis Based On Emergency CT In Patients With Spontaneous Intracranial Cerebral Hemorrhage

Background and purpose Spontaneous intracranial cerebral hemorrhage(s ICH)is a clinically common cerebrovascular emergency with a very high mortality and disability rate,bringing a heavy economic and mental burden to patients,families and society.Based on the patient’s first emergency head CT,this study summarized the risk factors for the deterioration of the early s ICH patients without cerebral hernia and poor prognosis,and provided a practical assessment model for early risk stratification of s ICH patients.Methods All patients were screened from the cerebral hemorrhage patient registration database(RIS-MIS-ICH Clinical Trials.gov Identifier: NCT03862729)established by our center,including sICH patients who had no cerebral hernia and preferred conservative treatment within 24 hours of onset.And the clinical and imaging features of the hematoma on CT,all patients were followed up for at least 1 year.The patients’ sudden GCS score decline or switch to surgical treatment was defined as worsening of the disease;patients with m RS score greater than or equal to 4 points 1 year after bleeding were defined as poor prognosis.According to the statistical analysis,the independent risk factors of patients’ early disease deterioration and poor prognosis after 1 year of bleeding were obtained.Based on the statistical results and clinical experience,each factor was assigned to establish a prediction model,and the accuracy of each model was analyzed using ROC curve.Results There were 123 sICH patients included in the first choice of conservative treatment,of which 86(70%)had follow-up registration.Admission GCS score and hematoma volume are independent risk factors for early disease progression.The admission GCS score is assigned 1-3 points,13 <GCS≤15 is 1 point,10 <GCS≤13 is2 points,8 ≤ GCS ≤ 10 is 3 points;hematoma volume ≤ 30 ml is assigned 1 point,hematoma volume>30ml is 2 points,forming a scoring model of early disease deterioration in s ICH patients with 2-5 points.ROC curve analysis shows that the scoring model is closely related to the deterioration of the patient’s condition.The area under the curve is 0.778 and the inflection point value is 3.5.Hemorrhage site and hematoma volume are independent risk factors for poor prognosis 1 year after hemorrhage,and island signs have a related trend(p = 0.051).The hematoma volume≤25ml is assigned a score of 1 and the hematoma volume> 25 ml is assigned a score of2;the emergency CT plain film on the island sign is assigned a score of 1;A scoring model of early deterioration of s ICH patients with 2-6 points.ROC curve analysis showed that the scoring model was closely related to the prognosis of patients 1 year after bleeding.The area under the curve was 0.792 and the inflection point value was4.5.Conclusion Patients with an early deterioration score of 4-5 have a higher risk of deterioration during hospitalization;patients with a prognosis score of 5-6 have a poorer prognosis one year after bleeding.