To investigate influencing factors for the occurrence of early neurological deterioration (END) in young and middle-aged patients with hypertensive intracerebral hemorrhage (HICH).

A retrospective study was used to analyze the clinical data of 205 young and middle-aged patients with HICH admitted to Neurosurgery Department of the Second Affiliated Hospital of Fuyang Normal University from January 2018 to December 2024. The patients were divided into END group and non-END group according to whether the patients suffered from END within 72 h after admission. Independent influencing factors for the occurrence of END were determined by multivariate Logistic regression analysis, and the Logistic regression prediction model was constructed based on them. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were employed to assess the capacity of different influencing factors in determining END.

Among 205 HICH patients, 35 cases showed END (the END group), and the incidence of END was 17.1%, the remaining 170 patients were in the non-END group. There was statistically significant difference in age, admission GCS score, admission volume of hematoma, site of HICH, rupturing into the ventricular system, first CT scan time, recurrent vomiting, systolic blood pressure at admission, diastolic blood pressure at admission and level of fibrinogen between the two groups (P<0.05). Multivariate binary Logistic regression analysis showed age, admission volume of hematoma, first CT scan time, recurrent vomiting were independent influencing factors for END. ROC curves showed that AUC of age, admission volume of hematoma, first CT scan time, recurrent vomiting were 0.700 (47 years as the threshold for age), 0.880 (15 mL as the threshold for admission volume of hematoma), 0.843 (2.1 h as the threshold for first CT scan time), 0.824. The AUC of the influencing factors combined to predict END was 0.948 (95%CI: 0.908-0.974, P<0.001), demonstrating superior predictive performance compared with individual single indicators.

Young and middle-aged patients with HICH show a high incidence of END, which is associated with age, admission hematoma volume, first CT scan time, and recurrent vomiting. In clinical practice, attention should be paid to these features to enable early identification and intervention of END, thereby improving patient prognosis.