Effect Of White Matter Lesions On The Long-term Prognosis In Patients Of Spontaneous Intracerebral Hemorrhage

Objective: Cerebral white matter lesions(WMLs)that was often called white matter hyperintensities(WMH)and leukoaraiosis(LA),might occur in a variety of diseases such as Alzheimer’s disease,vascular dementia,ischemic stroke,intracerebral hemorrhage(ICH)and other diseases.WMLs was associated with poor prognosis of ischemic stroke,but there are few studies that WMLs effected the prognosis of intracerebral hemorrhage.we investigated whether WMLs was associated with poor long-term prognosis in patients with spontaneous ICH.Methods: 1.We prospectively identified patients with spontaneous acute ICH at the neurology ward of a major hospital in Sichuan from January 01,2015 to April 30,2016.The clinical data of them were collected at admission.WMLs was identified on magnetic resonance imaging(MRI)scan and its severity was graded using the Fazekas method to include a score for the deep white matter and periventricular regions when patients were rechecked MRI scan.2.Baseline data and outcomes were compared between included and excluded patients.Inclued patients were divided into two groups according to prognosis at 6 months by the modified Rankin Scale(mRS): patients with good prognosis(mRS≤3)and patients with poor prognosis(mRS≥4).Univariate analysis was performed to determine the possible risk factors for the long-term prognosis of ICH,and then analyzed these possible risk factors with logistic regression analysis to detect independent risk factors for the long-term prognosis of ICH.The correlation analysis between the severity of WMLs and long-term outcomes showed that the trend of mutual change and correlation intensity by Goodman-Kruskal Gamma.Results: 1.A total of 178 ICH patients were enrolled,including 127 patients who were checked MRI scan with a follow-up of failure in 10 cases,and including 51 patients who were not checked MRI scan with incomplete data in 10 cases.There was statistically significant difference in comparing with history of hypertension,pulmonary infection,hematoma ruptured into ventricles,irregular hematoma,GCS score,NIHSS score,hematoma volume,hematoma location and 6 months m RS score between included patients and excluded patients.Excluding 10 cases failed to followed up,finally,a total of 117 cases were included in the study of factors influencing the long-term prognosis of cerebral hemorrhage.2.Univariate analysis demonstrated that age,smoking,pulmonary infection,hematoma ruptured into ventricles,irregular hematoma,hematoma volume,GCS score,NIHSS score,systolic blood pressure,the severity of white matter lesions(WMLs)were the factors that may affect the long-term prognosis of patients with spontaneous ICH.3.Multivariate analysis of the above factors showed that including NIHSS score(OR=3.467,95%CI:1.207~9.955,P<0.05)Age,(OR=1.065,95%CI:1.001~ 1.133,P<0.05),hematoma ruptured into ventricles(OR=5.475,95%CI,:1.428~ 20.994,P<0.05),hematoma volume(OR=2.366,95% CI:1.206~4.641,P<0.05),the severity of WMLs(OR=5.706,95%CI: 1.556~20.927,P<0.05)were the independent risk factors for poor long-term prognosis in patients with spontaneous ICH.4.both PWMLs and DWMLs Fazekas score were related to grade for mRS score and the correlation coefficient was 0.547 and 0.499.Conclusion: 1.The severity of WMLs was the independent risk factor for poor long-term outcomes of spontaneous ICH.2.PWMLs is more predictive of poor long-term prognosis of intracerebral hemorrhage than DWMLs.3.The severity of WMLs might be taken into account when assessed the long-term prognosis of acute spontaneous ICH,but the pathophysiological mechanism of affecting long-term prognosis of spontaneous ICH remains to be further studied.