A Retrospective Study Of Coagulopathy Related Cerebral Hemorrhage In Patients With Blood Diseases

Objective By analyzing the disease characteristics,risk factor classification(including general condition,platelet abnormality,coagulation dysfunction,and distribution of intracranial hemorrhage)and mRS Scores at admission and discharge,the influence of various indicators on cerebral hemorrhage was statistically analyzed,and the risk factors that may lead to poor prognosis of patients with cerebral hemorrhage were explored.So that early intervention can reduce the mortality and improve the prognosis.Methods A total of 39 patients with coagulopathy related cerebral hemorrhage admitted to the Department of Hematology,Zhejiang Provincal Hospital of TCM from June 2018 to December 2022 were retrospectively enrolled.The general condition and clinical characteristics were analyzed,and the patients with different blood diseases with coagulopathy were analyzed in subgroups.The coagulation indexes and imaging changes were observed to explore the influence of different degrees of coagulopathy and imaging changes on the prognosis of cerebral hemorrhage.The related factors included age of onset,gender,classification of blood diseases,clinical symptoms at admission,blood pressure,consciousness,bleeding site,and country International normalized ratio(PT INR),number of white blood cells,number of platelets,plasma prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),fibrinogen degradation product(FDP),D-dimer,etc.The severity of cerebral hemorrhage coma(GCS),National Institutes of Health Stroke Scale(NIHSS),coagulation dysfunction and functional outcome(mRS)were evaluated at the time of onset and discharge.Results ①1.A total of 39 eligible patients with cerebral hemorrhage were collected in this study,including 41 hemorrhage cases,of which 15(36%)had a good outcome and 26(64%)had an adverse outcome.The linear regression software was used for corresponding statistical and big data analysis,and it was found that the NIHSS score on admission(95%CI 1.24-3.18,P<0.05,VIF=2.9),degree of disturbance of consciousness(95%CI 5.47-217.19,P<0.001,VIF=4.39),dizziness,fatigue symptoms(95%CI 0.03-0.67,P<0.05,VIF=1.45),headache,nausea(95%CI 0.06-1.00,P<0.05,VIF=2.07)were risk factors for poor prognosis in patients with hematologic coagulodysfunction related cerebral hemorrhage(P<0.05),there was a statistical difference.②The col linearity of the four risk factors was detected and Variance Inflation Factor(VIF)was used to observe the collinearity among the factors.The VIF of all predictors in the study was less than 5,indicating that the collinearity among these predictors was not obvious or light.In this study,the area under the ROC curve(C index)was used to evaluate the differentiation of the prediction model.According to the ROC curve results,the C index of the prediction model was higher than 0.9,indicating that the prediction model had certain significance and high differentiation.Calibration Plot is developed with calibration plot to evaluate the accuracy of prediction,and Hosmer-Lemeshow test is carried out with the following results:X2=2.15,P=0.976>0.05,suggesting that there was no significant difference between the prediction results of the four risk factor prediction models and the original results,and the model fit well.③The enrolled patients with cerebral hemorrhage were divided into leukemia group,idiopathic thrombocytopenic purpura group,aplastic anemia group and other blood disease groups according to different blood diseases,and were divided into good prognosis and poor prognosis(death,automatic discharge)according to the conditions at discharge.SPSS 27.0 statistical software was used to analyze the data.It was found that the prothrombin time(PT)was longer in the leukemia group than in the other groups(F=8.294,P<0.001),the PT INR value increased(F=8.420,P<0.001),there were statistical differences,but there were no significant differences in leukocyte number,platelet number,thrombin time(TT),fibrinogen(FIB),D-dimer among the three groups(P<0.05).④According to Spearman’s correlation analysis,different bleeding sites and the total number of white blood cells were higher in patients with cerebral hemorrhage related to coagulation dysfunction of blood diseases(S=0.475,P<0.05),plasma prothrombin time(PT)was prolonged(S=0.408,P<0.05)and PT INR increased(S=0.417,P<0.05),D-dimer increased(S=0.343,P<0.05)there was a correlation.Conclusion First,for patients with cerebral hemorrhage related to blood disease coagulopathy,the NIHSS score at onset,the degree of disturbance of consciousness,dizziness,fatigue,headache,and nausea can predict the poor prognosis of patients to a greater extent.Second,At the onset of cerebral hemorrhage caused by leukemia,idiopathic thrombocytopenic purpura and aplastic anemia,the prothrombin time(PT)and international normalized ratio(PT INR)of leukemia group were significantly longer than those of other groups,and the prognosis was the worst.Third,different bleeding sites are correlated with high white blood cell counts,prolonged plasma prothrombin time(PT),elevated international normalized ratio(INR),and elevated D-dimer,which can be affected by these factors.Fourth,most patients with coagulopathy related cerebral hemorrhage have poor prognosis and high mortality.It is meaningful to conduct risk analysis and establish risk models to predict the prognosis of patients with coagulopathy related cerebral hemorrhage.