Analysis of risk factors and predictive value for chronic hydrocephalus following operation on hypertensive intracerebral hemorrhage

doi:10.3877/cma.j.issn.2095-123X.2019.06.007

Abstract

Abstract:

Objective

To investigate risk factors and predictive value for chronic hydrocephalus (HCP) following operation on hypertensive intracerebral hemorrhage (HICH).

Methods

Clinical data of 233 patients with HICH admitted to the hospital from January 2015 to June 2019 were retrospectively analyzed. Patients with chronic HCP were followed up within 3 months after discharge. Multiple logistic regression was performed to analyze risk factors of chronic HCP, and receiver operating characteristic (ROC) curve was used to assess the predictive value of indicators for chronic HCP. The maximum value of the Jordon index determines the cut-off value.

Results

Among the 233 patients with HICH, 49 cases (22.0%) developed chronic HCP. The proportion of cerebral hernia, modified Graeb scale (mGS) score and preoperative obstructive HCP in the HCP group was higher than that in the non-HCP group (P<0.05), and score of GCS was lower than that in the non-HCP group (P<0.05). The incidence of chronic HCP in patients without lumbar puncture was higher than that in patients with lumbar puncture (P<0.05). Multiple logistic regression analysis showed that cerebral hernia and mGS were the independent influencing factors associated with chronic HCP (P<0.05). However, lumbar puncture is a protective factor for chronic HCP in HICH patients (P<0.05). ROC curve showed that the area under the curve (AUC) of cerebral hernia and mGS, predicting chronic HCP was 0.646 and 0.821, respectively. Combined prediction of the two risk factors had an AUC of 0.857.

Conclusion

Cerebral hernia and mGS score are independent influencing factors for chronic HCP after HICH, and early release of cerebrospinal fluid after operation can reduce the occurrence of chronic HCP. The combination of the indicators can better predict the formation of chronic HCP.

Key words: Hypertensive intracerebral hemorrhage, Chronic Hydrocephalus, Receiver operating characteristic curve, Modified Graeb scale score

Haicheng Hu, Ruhai Wang. Analysis of risk factors and predictive value for chronic hydrocephalus following operation on hypertensive intracerebral hemorrhage[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2019, 09(06): 350-354.

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References 27

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部位	无出血	出血量占脑室比				合并脑室扩张
部位	无出血	≤25%	>25%且≤50%	>50%且≤75%	>75%	合并脑室扩张
第四脑室	0	2	2	4	4	1
第三脑室	0	2	2	4	4	1
左侧颞角	0	1	1	2	2	1
右侧颞角	0	1	1	2	2	1
左侧枕角	0	1	1	2	2	1
右侧枕角	0	1	1	2	2	1
左侧脑室	0	1	2	3	4	1
右侧脑室	0	1	2	3	4	1

部位	无出血	出血量占脑室比				合并脑室扩张
部位	无出血	≤25%	>25%且≤50%	>50%且≤75%	>75%	合并脑室扩张
第四脑室	0	2	2	4	4	1
第三脑室	0	2	2	4	4	1
左侧颞角	0	1	1	2	2	1
右侧颞角	0	1	1	2	2	1
左侧枕角	0	1	1	2	2	1
右侧枕角	0	1	1	2	2	1
左侧脑室	0	1	2	3	4	1
右侧脑室	0	1	2	3	4	1

因素		HCP组（n=49）	非HCP组（n=174）	χ²/t值	P值
性别[例（%）]		?	?	0.833	0.361
?	男	31（63.3）	122（70.1）	?	?
?	女	18（36.7）	52（29.9）	?	?
年龄（Mean±SD，岁）		58.61±10.41	60.13±10.37	0.905	0.366
出血部位[例（%）]		?	?	9.257	0.002
?	基底节区	31（73.5）	145（28.7）	?	?
?	丘脑	18（26.5）	29（71.3）	?	?
脑室外引流[例（%）]		?	?	32.293	<0.001
?	是	36（73.5）	50（28.7）	?	?
?	否	13（26.5）	124（71.3）	?	?
GCS评分（Mean±SD，分）		6.31±2.14	7.88±2.58	3.931	<0.001
脑疝[例（%）]		?	?	17.670	<0.001
?	是	23（46.9）	31（17.8）	?	?
?	否	26（53.1）	143（82.2）	?	?
梗阻性HCP[例（%）]		?	?	9.449	0.002
?	是	35（71.4）	19（10.9）	?	?
?	否	14（28.6）	155（89.1）	?	?
中脑导水管结构[例（%）]		?	?	0.405	0.524
?	清晰	2（4.8）	14（8.5）	?	?
?	不清晰	47（95.2）	160（91.5）	?	?
腰椎穿刺[例（%）]		?	?	3.870	0.049
?	是	17（34.7）	88（50.6）	?	?
?	否	32（65.3）	86（49.4）	?	?
去骨瓣减压[例（%）]		?	?	0.232	0.630
?	是	14（28.6）	56（32.2）	?	?
?	否	35（71.4）	118（67.8）	?	?
mGS评分（Mean±SD，分）		15.31±6.93	5.80±7.15	8.264	<0.001

因素		HCP组（n=49）	非HCP组（n=174）	χ²/t值	P值
性别[例（%）]		?	?	0.833	0.361
?	男	31（63.3）	122（70.1）	?	?
?	女	18（36.7）	52（29.9）	?	?
年龄（Mean±SD，岁）		58.61±10.41	60.13±10.37	0.905	0.366
出血部位[例（%）]		?	?	9.257	0.002
?	基底节区	31（73.5）	145（28.7）	?	?
?	丘脑	18（26.5）	29（71.3）	?	?
脑室外引流[例（%）]		?	?	32.293	<0.001
?	是	36（73.5）	50（28.7）	?	?
?	否	13（26.5）	124（71.3）	?	?
GCS评分（Mean±SD，分）		6.31±2.14	7.88±2.58	3.931	<0.001
脑疝[例（%）]		?	?	17.670	<0.001
?	是	23（46.9）	31（17.8）	?	?
?	否	26（53.1）	143（82.2）	?	?
梗阻性HCP[例（%）]		?	?	9.449	0.002
?	是	35（71.4）	19（10.9）	?	?
?	否	14（28.6）	155（89.1）	?	?
中脑导水管结构[例（%）]		?	?	0.405	0.524
?	清晰	2（4.8）	14（8.5）	?	?
?	不清晰	47（95.2）	160（91.5）	?	?
腰椎穿刺[例（%）]		?	?	3.870	0.049
?	是	17（34.7）	88（50.6）	?	?
?	否	32（65.3）	86（49.4）	?	?
去骨瓣减压[例（%）]		?	?	0.232	0.630
?	是	14（28.6）	56（32.2）	?	?
?	否	35（71.4）	118（67.8）	?	?
mGS评分（Mean±SD，分）		15.31±6.93	5.80±7.15	8.264	<0.001

指标	β	SE	Wald值	OR值	95%CI	P值
出血部位	1.066	0.359	8.793	2.903	1.435~5.873	0.003
脑室外引流	-1.927	0.364	27.964	0.146	0.071~0.297	0.000
GCS评分	-0.289	0.078	13.563	0.749	0.642~0.874	0.000
梗阻性HCP	1.183	0.399	8.793	3.263	1.493~7.131	0.003
脑疝	1.406	0.348	16.318	4.081	2.063~8.073	0.000
腰椎穿刺	-0.656	0.336	3.800	0.519	0.269~1.004	0.049
mGS评分	0.155	0.024	40.109	1.168	1.113~1.225	0.000

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