Determinants of acute and subacute case-fatality in elderly patients with hypertensive intracerebral hemorrhage

Role of disturbance coefficient in monitoring and treatment of cerebral edema in patients with cerebral hemorrhage

BACKGROUND

At present, the conventional methods for diagnosing cerebral edema in clinical practice are computed tomography (CT) and magnetic resonance imaging (MRI), which can evaluate the location and degree of peripheral cerebral edema, but cannot realize quantification. When patients have symptoms of diffuse cerebral edema or high cranial pressure, CT or MRI often suggests that cerebral edema is lagging and cannot be dynamically monitored in real time. Intracranial pressure monitoring is the gold standard, but it is an invasive operation with high cost and complications. For clinical purposes, the ideal cerebral edema monitoring should be non-invasive, real-time, bedside, and continuous dynamic monitoring. The disturbance coefficient (DC) was used in this study to dynamically monitor the occurrence, development, and evolution of cerebral edema in patients with cerebral hemorrhage in real time, and review head CT or MRI to evaluate the development of the disease and guide further treatment, so as to improve the prognosis of patients with cerebral hemorrhage.

AIM

To offer a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.

METHODS

A total of 160 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery, Second Affiliated Hospital of Xi'an Medical University from September 2018 to September 2019 were recruited. The patients were randomly divided into a control group (n = 80) and an experimental group (n = 80). Patients in the control group received conventional empirical treatment, while those in the experimental group were treated with mannitol dehydration under the guidance of DC. Subsequently, we compared the two groups with regards to the total dosage of mannitol, the total course of treatment, the incidence of complications, and prognosis.

RESULTS

The mean daily consumption of mannitol, the total course of treatment, and the mean hospitalization days were 362.7 ± 117.7 mL, 14.8 ± 5.2 days, and 29.4 ± 7.9 in the control group and 283.1 ± 93.6 mL, 11.8 ± 4.2 days, and 23.9 ± 8.3 in the experimental group (P < 0.05). In the control group, there were 20 patients with pulmonary infection (25%), 30 with electrolyte disturbance (37.5%), 20 with renal impairment (25%), and 16 with stress ulcer (20%). In the experimental group, pulmonary infection occurred in 18 patients (22.5%), electrolyte disturbance in 6 (7.5%), renal impairment in 2 (2.5%), and stress ulcers in 15 (18.8%) (P < 0.05). According to the Glasgow coma scale score 6 months after discharge, the prognosis of the control group was good in 20 patients (25%), fair in 26 (32.5%), and poor in 34 (42.5%); the prognosis of the experimental group was good in 32 (40%), fair in 36 (45%), and poor in 12 (15%) (P < 0.05).

CONCLUSION

Using DC for non-invasive dynamic monitoring of cerebral edema demonstrates considerable clinical potential. It reduces mannitol dosage, treatment duration, complication rates, and hospital stays, ultimately lowering hospitalization costs. Additionally, it improves overall patient prognosis, offering a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.

Analysis of Prognostic Factors for Drilling Drainage Surgery in Patients with Hypertensive Intracerebral Hemorrhage and Development of a Predictive Nomogram

Objective

To investigate the influencing factors affecting prognosis in patients undergoing drilling drainage surgery for hypertensive intracerebral hemorrhage (HICH) and to construct a nomogram predictive model.

Methods

Clinical data of 247 patients with HICH admitted to our hospital between October 2020 and February 2024 were retrospectively analyzed. Patients were divided into a modeling cohort (173 cases) and a validation cohort (74 cases). The modeling group was separated into a good prognosis group and a poor prognosis group based on postoperative prognosis.

Results

Among the 173 patients in the modeling cohort, 19 patients (10.98%) experienced poor prognosis. Multivariate logistic regression analysis showed that age, preoperative GCS score, diabetes history, systolic blood pressure, diastolic blood pressure, pulmonary infection and postoperative hematoma volume were the risk factors for the prognosis of drilling drainage surgery for patients with HICH (P<0.05). The AUC of the modeling group and validation group was 0.962 and 0.946, and the H-L test showed χ 2=7.105 and 7.246, with P<0.05 for both, indicating favorable consistency of the model. Decision curve analysis (DCA) showed high clinical utility of the nomogram model within the probability threshold range of 0.05 to 0.93.

Conclusion

Age, preoperative GCS score, history of diabetes, systolic blood pressure, diastolic blood pressure, pulmonary infection and postoperative hematoma volume are key prognostic factors affecting outcomes after drilling drainage surgery in HICH patients. The established nomogram model based on these variables accurately predicts the risk of poor postoperative prognosis and can serve as an effective clinical reference tool.

Clinical benefits of invasive intracranial pressure monitoring for spontaneous intracranial hemorrhage: a systematic review and meta-analysis

BACKGROUND

This meta-analysis evaluated the clinical benefits of invasive intracranial pressure (ICP) monitoring for spontaneous intracranial hemorrhage with specific focuses on the hypertensive intracerebral hemorrhage (ICH) subgroup and the outcomes when combined with minimally invasive surgery (MIS).

METHODS

PubMed and Embase were searched to identify studies comparing the clinical outcomes from ICP monitoring vs. non-ICP monitoring. Primary outcomes included in-hospital and 6-month mortality rates. Secondary outcomes were hospital length of stay (LOS), proportion of patients with poor 6-month functional outcomes, and central nervous system (CNS) infection rates. Subgroup analyses were performed on hypertensive ICH subgroup and on MIS vs. non-MIS subgroups. This study was registered in PROSPERO (CRD42024587974).

RESULTS

Thirteen studies involving 4,027 patients with spontaneous intracranial hemorrhage were included. Compared with non-ICP monitoring, ICP monitoring significantly reduced the 6-month mortality rate (43.33% vs. 28.67%, P < 0.00001), the proportion of patients with poor 6-month functional outcomes (70.49% vs. 56.71%, P = 0.0003), and hospital LOS (19.71 vs. 18.15 days, P = 0.001) but increased CNS infection rate (1.56% vs.7.49%, P < 0.00001). The hypertensive ICH subgroup analysis revealed that ICP monitoring significantly reduced in-hospital mortality rate (8.57% vs. 2.78%, P = 0.02), LOS (18.42 vs.14.54 days, P < 0.00001), and the proportion of patients with poor 6-month functional outcomes (60.00% vs. 38.77%, P = 0.001). When used with MIS, ICP monitoring significantly reduced the LOS (16.98 vs. 12.45 days, P < 0.00001) and the proportion of patients with poor 6-month functional outcomes (66.89% vs. 36.22%, P < 0.00001).

CONCLUSION

ICP monitoring improves short- and long-term outcomes in patients with spontaneous intracranial hemorrhage, particularly when combined with MIS therapy.

Development and validation of a prognostic nomogram based on the hub genes of patients with hypertensive intracerebral hemorrhage

OBJECTIVE

Hypertensive intracerebral hemorrhage (HICH) is frequently associated with high disability, high mortality, and poor prognosis. The present study aimed to identify genes associated with HICH to construct prognostic models to improve accuracy in predicting HICH prognosis.

METHODS

Hub genes were identified by screening out differentially expressed genes from data in the Gene Expression Omnibus database and conducting weighted gene co-expression network analysis. 68 patients with HICH were recruited and categorized based on prognosis. The univariate logistic, least absolute shrinkage and selection operator, and multivariate logistic regression models were then established based on clinical data and the identified hub genes. A prognostic model was constructed based on the nomogram score. The model was validated using receiver operating characteristic curve, C-index, calibration plots, and decision curve analysis. It was also compared to a prognostic model constructed based on clinical data alone. The prognostic value of the nomogram score was assessed in different subgroups.

RESULTS

Three hub genes: pro-platelet basic protein (PPBP), PDZ and LIM domain protein 1 (PDLIM1), and metalloproteinase 1 (TIMP1) were identified as significantly correlated to adverse outcomes in HICH. These hub genes, in combination with the clinical data, were used to construct a nomogram score system, which exhibited strong predictive power, excellent consistency between actual outcomes and predictions, and a higher net clinical benefit. HICH patients with high scores presented significantly worse outcome. Importantly, the developed nomogram score system was superior to the use of clinicopathological features in predicting HICH prognosis. The nomogram score system exhibited adequate predictive performance in different subgroups as well.

CONCLUSION

The nomogram score system based on PPBP, PDLIM1, and TIMP1 genes, along with clinical data, exhibited superior performance in predicting adverse outcome in HICH patients. This system could, therefore, be useful for guiding clinical decisions and providing valuable insight for designing individualized treatments for HICH patients.

Relationship between changes in neurological deficit severity and adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage: a retrospective cohort study

OBJECTIVE

To explore the relationship between changes in neurological deficit severity and the occurrence of adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage.

METHODS

Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of NIHSS scores for adverse cardiac events.

RESULTS

There were significant differences between the two groups. Multivariate logistic regression analysis showed that advanced age, high NIHSS score, large intracerebral hemorrhage volume, and high CK level were independent risk factors for adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage (p < 0.05). The NIHSS scores of both groups gradually increased after admission, peaking at 48 h after admission. In Group A, this elevation persisted until 72 h after admission, while in Group B, there was a significant decrease at 72 h after admission (p < 0.05). From admission to 7 days after admission, the NIHSS scores in Group A were higher than those in Group B (p < 0.05). The area under the curve (AUC) of the NIHSS scores at 48 h after admission was 0.776, with sensitivity and specificity of 80.9% and 84.5%, respectively, which were higher than those of other indicators (p < 0.05).

CONCLUSION

The occurrence of adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage is influenced by multiple factors, and as the NIHSS score increases, the risk of such events gradually increases. Clinicians should pay attention to monitoring NIHSS scores after admission, as they have value in predicting adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage.