Analysis of risk factors for 30-day mortality in primary brainstem hemorrhage

doi:10.3877/cma.j.issn.2095-123X.2024.04.004

Abstract

Abstract:

Objective

To analyze the risk factors associated with 30-day mortality in patients with primary brainstem hemorrhage (PBSH).

Methods

A retrospective analysis was performed on the clinical data of 101 patients with PBSH who were admitted to the Neurosurgery Department of Rizhao People’s Hospital from June 2019 to December 2023, including gender, age, medical history, blood glucose levels, body mass index (BMI), GCS score at admission, volume of blood clot, surgical interventions undertaken,maximum transverse diameter of the blood clot on CT imaging,and instances of intracranial hemorrhage.According to whether the patients died within hospitalization and 30-day after discharge, all patients were divided into survival group and death group.The risk factors associated with 30-day mortality were evaluated using Kaplan-Meier survival curves and Cox regression analysis.

Results

Among the 101 patients, 66 (65.4%) were in the survival group and 35 (34.6%) were in the death group.The proportion of patients with admission GCS score＜8 scores, total hematoma volume≥5 mL, concomitant intraventricular hemorrhage, and the longest diameter of haematoma transected at the level of the largest CT dimension≥2.6 cm between the two groups showed statistically significant differences (P＜0.05).Cox’s multifactorial regression analysis showed that the longest diameter of haematoma transected at the level of the largest CT dimension≥2.6 cm(HR=3.37,95%CI:1.10-10.37,P=0.034), and GCS score ＜8 scores (HR=20.18, 95%CI: 2.53-160.80, P=0.005) were independent risk factors affecting the 30-day mortality of patients with PBSH.

Conclusion

The 30-day mortality rate was significantly higher in PBSH patients with lower GCS scores at admission and a longer maximal transverse diameter at the largest hematoma level on CT.The critical role of these two indicators in prognostic evaluation should be emphasized in clinical practice.

Key words: Primary brainstem hemorrhage, Risk factor, Prognosis

Mingtao Bai, Baochen Huang, Jijie Niu, Yuhai Zhang, Zhenxin Mu. Analysis of risk factors for 30-day mortality in primary brainstem hemorrhage[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(04): 213-217.

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References 19

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项目	生存组（n=66）	死亡组（n=35）	χ ² /t值	P值
年龄（岁，Mean±SD）	55.2±12.7	50.7±12.5	3.036	0.273
女性[例（%）]	19（28.8）	10（28.6）	0.001	0.654
入院GCS评分＜8分[例（%）]	26（39.4）	34（97.1）	31.629	0.001
高血压病史[例（%）]	59（89.4）	33（94.3）		0.566
糖尿病病史[例（%）]	8（12.1）	4（11.4）		0.692
抗板药物服用史[例（%）]	7（10.6）	4（11.4）		0.905
入院收缩压≥160mmHg[例（%）]	55（83.3）	29（82.9）	0.004	0.776
入院血糖≥8.3mmol/L[例（%）]	20（30.3）	13（37.1）	0.486	0.672
BMI[例（%）]			0.367	0.189
＜24kg/m²	17（25.8）	22（34.3）
≥24kg/m²	49（74.2）	23（65.7）
治疗方式[例（%）]				0.375
手术治疗	5（7.6）	7（20.0）
内科保守治疗	61（92.4）	28（80.0）
合并脑室出血[例（%）]	13（19.7）	14（40.0）	4.813	0.021
CT最大血肿层面横断位最长径≥2.6cm[例（%）]	23（34.8）	31（88.6）	26.531	＜0.001
血肿体积≥5mL[例（%）]	21（31.8）	21（60.0）	7.478	0.014

项目	生存组（n=66）	死亡组（n=35）	χ ² /t值	P值
年龄（岁，Mean±SD）	55.2±12.7	50.7±12.5	3.036	0.273
女性[例（%）]	19（28.8）	10（28.6）	0.001	0.654
入院GCS评分＜8分[例（%）]	26（39.4）	34（97.1）	31.629	0.001
高血压病史[例（%）]	59（89.4）	33（94.3）		0.566
糖尿病病史[例（%）]	8（12.1）	4（11.4）		0.692
抗板药物服用史[例（%）]	7（10.6）	4（11.4）		0.905
入院收缩压≥160mmHg[例（%）]	55（83.3）	29（82.9）	0.004	0.776
入院血糖≥8.3mmol/L[例（%）]	20（30.3）	13（37.1）	0.486	0.672
BMI[例（%）]			0.367	0.189
＜24kg/m²	17（25.8）	22（34.3）
≥24kg/m²	49（74.2）	23（65.7）
治疗方式[例（%）]				0.375
手术治疗	5（7.6）	7（20.0）
内科保守治疗	61（92.4）	28（80.0）
合并脑室出血[例（%）]	13（19.7）	14（40.0）	4.813	0.021
CT最大血肿层面横断位最长径≥2.6cm[例（%）]	23（34.8）	31（88.6）	26.531	＜0.001
血肿体积≥5mL[例（%）]	21（31.8）	21（60.0）	7.478	0.014

因素	偏回归系数	标准误	Waldχ²值	P值	HR值	95%CI
CT最大血肿层面横断位最长径≥2.6cm	1.215	0.573	2.120	0.034	3.37	1.10～10.37
手术治疗	-0.781	0.534	-1.461	0.144	0.46	0.16～1.31
合并脑室出血	0.587	0.420	1.398	0.162	1.80	0.79～4.09
入院GCS评分＜8分	3.005	1.059	2.838	0.005	20.18	2.53～160.80
血肿体积≥5mL	0.214	0.415	0.517	0.605	1.24	0.55～2.79
入院血糖≥8.3mmol/L	-0.747	0.396	-1.888	0.059	0.47	0.22～1.03
BMI≥24kg/m²	-0.298	0.390	-0.764	0.445	0.74	0.35～1.59

因素	偏回归系数	标准误	Waldχ²值	P值	HR值	95%CI
CT最大血肿层面横断位最长径≥2.6cm	1.215	0.573	2.120	0.034	3.37	1.10～10.37
手术治疗	-0.781	0.534	-1.461	0.144	0.46	0.16～1.31
合并脑室出血	0.587	0.420	1.398	0.162	1.80	0.79～4.09
入院GCS评分＜8分	3.005	1.059	2.838	0.005	20.18	2.53～160.80
血肿体积≥5mL	0.214	0.415	0.517	0.605	1.24	0.55～2.79
入院血糖≥8.3mmol/L	-0.747	0.396	-1.888	0.059	0.47	0.22～1.03
BMI≥24kg/m²	-0.298	0.390	-0.764	0.445	0.74	0.35～1.59

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