Risk factors for prognosis in patients with primary brainstem hemorrhage

doi:10.3877/cma.j.issn.2095-9141.2023.02.004

Abstract

Abstract:

Objective

To explore the risk factors affecting death and functional recovery in patients with primary brainstem hemorrhage (PBH).

Methods

A retrospective analysis of the patients with brain stem hemorrhage admitted by Neurosurgery Department of Beijing Chao-yang Hospital, Capital Medical University from January 2016 to November 2021 was made. The general data, neurological signs at admission, laboratory tests, hematoma volume and treatment methods of the patients were collected, and the patients were divided into survival group and death group according to their survival status 30 d after the onset of the disease. From follow up to 90 d after onset, patients were divided into good prognosis group (mRS score 0-2) and poor prognosis group (mRS score 3-5) based on the modified Rankin scale (mRS) score. Risk factors for 30 d death and 90 d inability to take care of themselves in patients with PBH were analyzed and screened.

Results

A total of 36 patients with PBH were included, 30 patients (83.3%) received conservative treatment, and 6 cases (16.7%) underwent surgical treatment, including 23 patients in the survival group (63.9%) and 13 patients in the death group (36.1%). From follow up to 90 d after onset, there were 14 cases in good prognosis group and 9 cases in poor prognosis group. The results of univariate analysis showed that there was a statistically significant difference in heart rate, GCS score, and mechanical ventilation between the survival group and the death group (P<0.05); there were statistically significant differences in GCS scores, bilateral light reflex disappearance, mechanical ventilation, absolute values of white blood cell, hematoma volume >5 mL, and hematoma breaking into the ventricle between the good prognosis group and the poor prognosis group (P<0.05). Multivariate Logistic regression analysis showed that GCS score ≤8 (OR=15.893, 95%CI: 1.528-165.323, P=0.021) was a risk factor for death in patients with PBH.

Conclusion

Deep coma upon admission is an important risk factor for death and poor prognosis in patients with PBH.

Key words: Primary brainstem hemorrhage, Disability, Prognosis

Yibo Geng, Yiqi Liu, Xiaoli Liu, Yang Wang, Zheng Gu, Yinglun Song, Tao Li, Tong Li, Ke Tan, Yan Wang, Yunna Yang, Jinping Li. Risk factors for prognosis in patients with primary brainstem hemorrhage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(02): 85-90.

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References 23

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项目	生存组（n=23）	死亡组（n=13）	χ²/t/Z值	P值
男[例（%）]	16（69.6）	11（84.6）	-	0.438
年龄（岁，±s）	56.2±12.8	55.9±7.8	0.108	0.914
发病到就诊时间[h，M（P₂₅，P₇₅）]	8.0（4.0，24.0）	5.0（3.0，27.0）	-1.157	0.253
BMI（kg/m²，±s）^a	25.9±5.4	26.5±0.7	-0.215	0.832
心率（次/min，±s）	78.3±9.0	113.3±27.2	-4.507	0.001
入院收缩压（mmHg，±s）	155.3±24.6	143.6±54.8	0.726	0.479
入院舒张压（mmHg，±s）	89.7±14.9	81.6±30.8	0.889	0.388
GCS评分≤8分[例（%）]	5（21.7）	10（76.9）	-	0.002
双侧光反消失[例（%）]	3（13.1）	4（30.8）	-	0.225
机械通气[例（%）]	3（13.0）	7（53.8）	-	0.018
血白细胞绝对值（×10⁹，±s）^b	9.87±3.37	11.03±3.77	-0.944	0.352
血肿体积>5 mL[例（%）]	6（26.1）	7（53.8）	-	0.150
破入脑室[例（%）]	4（17.4）	5（38.5）	-	0.220
手术治疗[例（%）]	2（8.7）	4（30.8）	-	0.161

项目	生存组（n=23）	死亡组（n=13）	χ²/t/Z值	P值
男[例（%）]	16（69.6）	11（84.6）	-	0.438
年龄（岁，±s）	56.2±12.8	55.9±7.8	0.108	0.914
发病到就诊时间[h，M（P₂₅，P₇₅）]	8.0（4.0，24.0）	5.0（3.0，27.0）	-1.157	0.253
BMI（kg/m²，±s）^a	25.9±5.4	26.5±0.7	-0.215	0.832
心率（次/min，±s）	78.3±9.0	113.3±27.2	-4.507	0.001
入院收缩压（mmHg，±s）	155.3±24.6	143.6±54.8	0.726	0.479
入院舒张压（mmHg，±s）	89.7±14.9	81.6±30.8	0.889	0.388
GCS评分≤8分[例（%）]	5（21.7）	10（76.9）	-	0.002
双侧光反消失[例（%）]	3（13.1）	4（30.8）	-	0.225
机械通气[例（%）]	3（13.0）	7（53.8）	-	0.018
血白细胞绝对值（×10⁹，±s）^b	9.87±3.37	11.03±3.77	-0.944	0.352
血肿体积>5 mL[例（%）]	6（26.1）	7（53.8）	-	0.150
破入脑室[例（%）]	4（17.4）	5（38.5）	-	0.220
手术治疗[例（%）]	2（8.7）	4（30.8）	-	0.161

项目	预后良好组（n=14）	预后不良组（n=9）	t值	P值
男[例（%）]	10（71.4）	6（66.7）		1.000
年龄（岁，±s）	59.5±11.7	51.1±13.4	1.585	0.128
BMI（kg/m²，±s）^a	24.6±4.1	31.0±7.7	-2.040	0.062
机械通气[例（%）]	0（0）	3（33.3）		0.047
心率（次/min，±s）	76.2±8.8	81.6±8.8	-1.438	0.165
入院收缩压（mmHg，±s）	154.4±20.1	156.6±31.6	-0.198	0.845
入院舒张压（mmHg，±s）	89.1±12.5	90.7±18.9	-0.245	0.809
GCS评分≤8分[例（%）]	0（0）	5（55.6）		0.004
双侧光反消失[例（%）]	0（0）	3（33.3）		0.047
血白细胞绝对值（×10⁹，±s）^b	8.3±2.8	12.1±2.9	-3.039	0.006
血肿体积>5 mL[例（%）]	1（7.1）	5（55.6）		0.018
破入脑室[例（%）]	0（0）	4（44.4）		0.014
手术治疗[例（%）]	0（0）	2（22.2）		0.142

项目	预后良好组（n=14）	预后不良组（n=9）	t值	P值
男[例（%）]	10（71.4）	6（66.7）		1.000
年龄（岁，±s）	59.5±11.7	51.1±13.4	1.585	0.128
BMI（kg/m²，±s）^a	24.6±4.1	31.0±7.7	-2.040	0.062
机械通气[例（%）]	0（0）	3（33.3）		0.047
心率（次/min，±s）	76.2±8.8	81.6±8.8	-1.438	0.165
入院收缩压（mmHg，±s）	154.4±20.1	156.6±31.6	-0.198	0.845
入院舒张压（mmHg，±s）	89.1±12.5	90.7±18.9	-0.245	0.809
GCS评分≤8分[例（%）]	0（0）	5（55.6）		0.004
双侧光反消失[例（%）]	0（0）	3（33.3）		0.047
血白细胞绝对值（×10⁹，±s）^b	8.3±2.8	12.1±2.9	-3.039	0.006
血肿体积>5 mL[例（%）]	1（7.1）	5（55.6）		0.018
破入脑室[例（%）]	0（0）	4（44.4）		0.014
手术治疗[例（%）]	0（0）	2（22.2）		0.142

因素	β	SE	Wald χ²	P值	OR	95%CI
男性	0.607	1.106	0.301	0.583	1.835	0.210~16.022
GCS评分≤8分	2.766	1.195	5.358	0.021	15.893	1.528~165.323
双侧光反消失	1.870	1.576	1.408	0.235	6.491	0.296~142.557
血肿体积>5 mL	0.632	1.203	0.276	0.599	1.881	0.178~19.900
手术治疗	1.421	1.497	0.901	0.343	4.141	0.220~77.866
机械通气	1.868	1.364	1.875	0.171	6.477	0.447~93.919

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