| Objective: The present study aimed to explore whether noncontrast CT imaging markers combined with serum calcium can improve the prognostic value of predicting hematoma enlargement and prognosis in spontaneous intracerebral hemorrhage patients.Methods:(1)The study population was selected according to the entry and exclusion criteria,collect all kinds of patient data,including imaging,laboratory data,etc.The special signs of NCCT were judged by two neurologists through blind method.(2)The subjects were divided into two groups: enlarged hematoma and unenlarged hematoma.The baseline data of the two groups were compared by univariate analysis to analyze whether there were differences in NCCT markers and serum calcium between the two groups.(3)The best cutoff value of serum calcium for predicting hematoma enlargement was determined by the(ROC)curve of subjects’ working characteristics.according to the results,serum calcium less than cutoff value was defined as CA(L),serum calcium greater than or equal to cutoff value CA(H),with special signs was defined as NM(+),and no special signs were defined as NM(-).Different combinations of NM and CA are made as follows: CA(L)NM(+): CA is less than the cutoff value and NM(+),CA(H)NM(+): CA is greater than or equal to the cutoff value and NM(+),CA(L)NM(-): CA is less than the cutoff value and HD(-),CA(H)NM(-): CA is greater than or equal to the cutoff value and HD(-).(4)Multivariate Logistic regression model was used to observe the difference in the risk of hematoma enlargement in different combinations compared with the double negative control group CA(H)NM(-).(5)The percentage histogram was used to compare the difference of different combinations of CA and NM in predicting hematoma enlargement.(6)To compare the diagnostic value of CA(L)or NM(+)alone and different combinations in predicting hematoma enlargement.(7)The prognosis of the patients after 90 days of discharge was evaluated by the(m RS)score.According to the m RS score,the patients were divided into two groups: good prognosis group(m RS ≤ 2)and poor prognosis group(m RS > 2).The baseline data of the two groups were compared by univariate analysis to analyze the difference of NCCT markers and serum calcium between the two groups.Results:(1)A total of 401 patients with spontaneous cerebral hemorrhage confirmed by noncontrast CT in Baotou Central Hospital from May 2018 to November 2020 were collected.(2)In the single factor of hematoma enlargement,compared with the patients without hematoma enlargement,the patients with hematoma enlargement had a higher incidence of NCCT markers and lower serum calcium.(3)According to the results of ROC curve,the best cut-off value of serum calcium for predicting hematoma enlargement was 1.8mmol/L.(4)In multivariate Logistic regression analysis,the risk of hematoma enlargement was higher in,CA(H)NM(+)group(OR=1.994(1.984,2.720)P < 0.001),and CA(L)NM(-)(OR=3.135(2.739,12.994),P=0.002)than in CA(H)NM(-)group,while the risk of hematoma enlargement was the highest in CA(L)NM(+)group(OR=5.310(4.786,13.439),P< 0.001).(5)The proportion of hematoma enlargement in different groups was: NM(+)and CA(L)group: 71.8%,NM(-)CA(L)group: 62.3%,NM(+)CA(H)group: 37.63%,NM(-)CA(H)group: 10%.The above results were compared between the two groups,the difference was statistically significant(p< 0.001).(6)Comparing the diagnostic value of CA(L)or NM(+)alone and different combinations in predicting hematoma enlargement,it was found that the sensitivity(0.814),positive predictive value(0.448),negative predictive value(0.907)and AUC(0.729)of predicting hematoma enlargement were the highest when CA(L)and NM(+)existed at the same time.When either or both CA(L)and NM(+)existed,the specificity of predicting hematoma enlargement(0.675)was the highest.(7)In the univariate analysis of poor prognosis,the incidence of NCCT markers in the poor prognosis group was higher than that in the good prognosis group(P< 0.001),but there was no significant difference in serum calcium value(P> 0.05).Conclusion:(1)Noncontrast CT imaging markers combined with serum calcium can improve the accuracy of predicting hematoma enlargement in spontaneous intracerebral hemorrhage.(2)Compared with the good prognosis group,the incidence of NCCT markers in the poor prognosis group was higher(P< 0.001),but there was no significant difference in serum calcium value(P> 0.05). |
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