The Risk Factors Of Early Hematoma Enlargement In Spontaneous Intracerebral Hemorrhage And Its Effect For The Prognosis

Objective: To investigate the risk factors of spontaneous intracerebralhemorrhage hematoma enlargement and its relationship with theprognosis.Materials and methods:1.We prospectively registered consecutive casesof acute spontaneous intracerebral hemorrhage at the neurology ward andneurosurgery ward of the Sichuan Provincial People’s Hospital from June01,2012to November1,2013. Patients with spontaneous intracerebralhemorrhage within24hours of symptom onset were included; all therelevant clinic and laboratory examination data, which influencedhematoma enlargement were collected. Patients should be recheckedbrain CT or MRI scan within24hours after admission or whenneurological deficit deterioration happened. Hematoma enlargement wasjudged by comparing brain CT scan and MRI. If the hematoma volumeincreased by33%or the diameter increased by10%, the hematoma wouldbe regared as enlargment. Patients were divided into hematomaenlargement (HE) group or non-HE (NHE) group according to thisjudgement.2. We got the information about prognosis by phone call oroutpatient clinic after3months and6months since patient’s symptomonset. The main contents of the follow-up visit included:1). Survival state2). Disability state. Disability was judged by Modified Rankin Scale(MRS), MRS≥3points was defined to be disability, MRS＜3pointswas defined to be non-disability.3. Measurement data were expressed asMean±SD or median. Differences among groups were analyzed byStudent t test when the data met normal distribution. If the dates metnon-normal distribution, rank sum test were used. Qualitative data weredescribed as percentages and analyzed by using Chi-square (χ2) test.Influencing factors were analyzed by using univariate analysis to get therisky factors about hematoma enlargement. When univariate analysesshowed P≤0.10, multivariate logistical regression was utilized to detectthe independent impact factors of hematoma enlargement. If thedependent variable was dichotomization classification variable formultivariate logistical regression, Binary Logistic regression was used.Influencing factors about death/dependence (death) of patients’ symptomonset after3month and6month, were analyzed by using univariateanalysis while using multivariate logistical regression when it showedP≤0.10. Results:1. There were233cases included, among which157cases were male（67.4%）and76cases were female（32.6%）；The agerange of the cases was21-92years old（61.5±14.3）；there were46casesoccurred in hematoma enlargement accounting for19.7%while187casesdid not accounting for80.3%of all cases.2. Most hematoma enlargementoccurred within6hours. Hematoma enlargement sites were mostly located in Basal ganglia and shapes were irregular.3. There wasstatistically significant difference about hematoma shape and symptomonset to first CT scan time between the two groups. Multivariate Logisticregression analysis demonstrated that admission hematoma shape (OR3.125,95%CI1.188～8.215), symptom onset to first CT time (OR4.862,95%CI1.705～13.862) were independent predictors ofspontaneous hematoma enlargement. After3month and6month sincepatient’s symptom onset, the follow-up visit showed the differencebetween two groups had statistically significant.4. Hematomaenlargement exacerbating neurological impairment and severe prognosiswere independent predictors of spontaneous cerebral hemorrhageprognosis.5. HE were the risk factors of death/dependence after symptomonset for cerebral hemorrhage. Logistic regression analysis demonstratedthat HE （OR9.098,95%CI3.991～20.741） was the independentpredictor of death/dependence at3months after spontaneous cerebralhemorrhage, HE（OR6.844,95%CI2.818～16.626）was the independentpredictor of death at6months after spontaneous cerebral hemorrhage.Conclusion:1.The incidence of early hematoma enlargement was high.2.Early hematoma enlargement exacerbating neurological impairment, itwas the independent predictor for the prognosis of spontaneous cerebralhemorrhage.3. Hematoma shape and spontaneous hemorrhagic onset tofirst brain CT scan time were independent predictors of hematoma enlargement.4. It is necessary to detected hematoma enlargementpromptly and adjust therapy in time.