Original article

Risk factor analysis of hematoma volume of cerebral hemorrhage in different location

Expand
  • Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2020-05-21

  Online published: 2022-07-25

Abstract

Objective To analyze risk factors of hematoma volume of cerebral hemorrhage in different location. Methods A total of 373 patients with cerebral hemorrhage from 2013 to 2017 years in our hospital were enrolled. According to the hemorrhage location, the patients were divided into basal ganglia hemorrhage group and lobar hemorrhage group, and the clinical data were analyzed retrospectively. Results Compared with lobar hemorrhage group, the average systolic blood pressure (P=0.034) and diastolic blood pressure (P=0.001), the content of serum uric acid (P=0.001) were higher in basal ganglia hemorrhage group, in which the patient had a higher proportion of the history of hypertension (P<0.001) and alcohol drinking (P=0.034). The average age (P<0.001), the levels of fibrin degradation product(FDP)(P=0.001) and D-dimers (P=0.003), the hematoma volume(P<0.001) in lobar hemorrhage group were higher than ganglia hemorrhage group, and the patients in lobar group had a higher proportion of the history of cerebral hemorrhage (P=0.02). Binary Logistics regression analysis showed that the risk of lobar hemorrhage increased 5.7%(P<0.001) when age increased one additional year. The risk of recurrent lobar hemorrhage was 3.27 times than that of basal ganglia hemorrhage (P=0.025) as the patients had a history of cerebral hemorrhage, and the risk of recurrent lobar hemorrhage was 0.477 times (P=0.031) than that of basal ganglia hemorrhage as the patients had a history of hypertension. Using multivariable linear regression to analyze hematoma volume change, we found that age (β=-1.04, P=0.002), international normalized ratio(INR)(β=14.219, P=0.008), the content of uric acid (β=-0.008, P=0.046), high density lipoprotein cholesterol (β=5.393, P=0.003), antiplatelet therapy (β=4.706, P=0.002) were independent predictive factors of basal ganglia cerebral hemorrhage. While the content of uric acid (β=-0.041, P=0.015), prior drinking history (β=-15.189, P=0.010), prior smoking history (β=12.579, P=0.005) and history of ischemic stroke (β=12.899, P=0.031) were independent predictive factors of lobar hemorrhage. Conclusions The risk factors of basal ganglia and lobar hematoma volume were different, and their independent predictive factors of hematoma volume were only partially overlapped. It suggests that the pathophysiological mechanisms determining the hematoma volume are not same in different locations.

Cite this article

DENG Weiping, YANG Zhao, LIU Jianrong . Risk factor analysis of hematoma volume of cerebral hemorrhage in different location[J]. Journal of Internal Medicine Concepts & Practice, 2021 , 16(05) : 331 -336 . DOI: 10.16138/j.1673-6087.2021.05.009

References

[1] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019)[J]. 中华神经科杂志, 2019, 52(12): 994-1005.
[2] Mente A, O’Donnell M, Rangarajan S, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies[J]. Lancet, 2016, 388(10043): 465-475.
[3] Gross BA, Jankowitz BT, Friedlander RM. Cerebral intraparenchymal hemorrhage[J]. JAMA, 2019, 321(13): 1295-1303.
[4] Wahab KW, Tiwari HK, Ovbiagele B, et al. Genetic risk of spontaneous intracerebral hemorrhage: systematic review and future directions[J]. J. Neurol Sci, 2019, 15; 407.
[5] Marini S, Devan WJ, Radmanesh F, et al. 17p12 Influences hematoma volume and outcome in spontaneous intracerebral hemorrhage[J]. Stroke, 2018, 49(7): 1618-1625.
[6] Fraser SM, Torres GL, Cai C, et al. Race is a predictor of withdrawal of life support in patients with intracerebral hemorrhage[J]. J Stroke Cerebrovasc Dis, 2018, 27(11): 3108-3114.
[7] Suda S, Aoki J, Shimoyama T, et al. Characteristics of acute spontaneous intracerebral hemorrhage in patients receiving oral anticoagulants[J]. J Stroke Cerebrovasc Dis, 2019, 28(4):1007-1014.
[8] Judge C, Ruttledge S, Costello M, et al. Lipid lowering therapy, low-density lipoprotein level and risk of intracerebral hemorrhage[J]. J Stroke Cerebrovasc Dis, 2019, 28(6):1703-1709.
[9] Hansen BM, Ullman N, Muschelli J, et al. Relationship of white matter lesions with intracerebral hemorrhage expansion and functional outcome[J]. Neurocrit Care, 2020, 33(2): 516-524.
[10] Lee SH, Kim BJ, Roh JK. Silent microbleeds are associated with volume of primary intracerebral hemorrhage[J]. Neurology, 2006, 66(3): 430-432.
[11] van Drimmelen-Krabbe JJ, Bradley WG, Orgogozo JM, et al. The application of the international statistical classification of diseases to neurology: ICD-10 NA[J]. J Neurol Sci, 1998, 161(1): 2-9.
[12] Rodriguez-Luna D, Rodriguez-Villatoro N, Juega JM, et al. Prehospital systolic blood pressure is related to intracerebral hemorrhage volume on admission[J]. Stroke, 2018, 49(1); 204-206.
[13] Morotti A, Charidimou A, Phuah CL, et al. Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage[J]. JAMA Neurol, 2016, 73(11): 1285-1290.
[14] Jafari M, Di Napoli M, Datta YH, et al. The role of serum calcium level in intracerebral hemorrhage hematoma expansion[J] Neurocrit Care, 2019, 31(1): 188-195.
[15] Wang K, Zhang Y, Zhong C, et al. Increased serum total bile acids can be associated with a small hematoma volume and decreased clinical severity during acute intracerebral hemorrhage[J]. Curr Neurovasc Res, 2018, 15(2): 158-163.
[16] Falcone GJ, Biffi A, Brouwers HB, et al. Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage[J]. JAMA Neurol, 2013, 70(8): 988-994.
[17] Franco L, Paciaroni M, Enrico ML, et al. Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents, oral anticoagulants or no antithrombotic therapy[J]. Eur J Intern Med, 2020, 75: 35-43.
[18] van Ginneken V, Engel P, Fiebach JB, et al. Prior antiplatelet therapy is not associated with larger hematoma volume or hematoma growth in intracerebral hemorrhage[J]. Neurol Sci, 2018, 39(4): 745-748.
[19] Camps-Renom P, Alejaldre-Monforte A, Delgado-Mederos R, et al. Does prior antiplatelet therapy influence hematoma volume and hematoma growth following intracerebral hemorrhage?[J]. Eur J Neurol, 2017, 24(2): 302-308.
[20] Seiffge DJ, Goeldlin MB, Tatlisumak T, et al. Meta-analysis of haematoma volume, haematoma expansion and mortality in intracerebral haemorrhage associated with oral anticoagulant use[J]. J Neurol, 2019, 266(12) :3126-3135.
[21] Chen H, Li F, Wang X, et al. Retrospective analysis of the predictive effect of routine biochemical results on the prognosis of intracerebral hemorrhage[J]. Acta Neurochir Suppl, 2011,111: 403-406.
[22] Xiao N, Liu TL, Li H, et al. Low serum uric acid levels promote hypertensive intracerebral hemorrhage by disrupting the smooth muscle cell-elastin contractile unit and upregulating the Erk1/2-MMP axis[J]. Transl Stroke Res, 2020, 11(5): 1077-1094.
[23] Zhou Z, Liang Y, Lin J, et al. Serum uric acid concentrations and risk of intracerebral hemorrhage[J]. Atherosclerosis, 2018, 275: 352-358.
[24] Karagiannis A, Mikhailidis DP, Tziomalos K, et al. Serum uric acid as an independent predictor of early death after acute stroke[J]. Circ J, 2007, 71(7): 1120-1127.
[25] O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study)[J]. Lancet, 2010, 376(9735): 112-123.
[26] Judge C, Ruttledge S, Costello M, et al. Lipid lowering therapy, low-density lipoprotein level and risk of intracerebral hemorrhage[J]. J Stroke Cerebrovasc Dis, 2019, 28(6): 1703-1709.
[27] O’Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE)[J]. Lancet, 2016, 388(10046): 761-775.
[28] Chen CJ, Brown WM, Moomaw CJ, et al. Alcohol use and risk of intracerebral hemorrhage[J]. Neurology, 2017, 88(21): 2043-2051.
Outlines

/