Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Neurol India. 2022 Jul-Aug;70(4):1562-1567. doi: 10.4103/0028-3886.355134.
Spontaneous intracerebral hemorrhage (SICH) accounts for 7.5%-30% of all strokes and carries higher morbidity and mortality. Raised blood urea nitrogen and creatinine ratio (BUNR) is a marker of dehydration and related to poor outcome in stroke patients. However, the ratio varies between 15 and 80 in different studies. The aim of the present study was to assess BUNR as an independent predictor of mortality and its sensitivity and specificity in predicting outcome in the SICH population.
Patients above the age of 18 years with SICH who were admitted in the Department of Neurology at Sir Sunderlal Hospital, Banaras Hindu University between January 2018 and July 2020 were enrolled in the study and prospectively followed up. Demographic, clinical, radiological, and outcome parameters were recorded.
A total of 217 patients were included. Of these, 137 (63%) were males. Seventy-one patients died during the initial 30 days. Number of patients with intraventricular hemorrhage (IVH; P = 0.003), higher mean intracerebral hemorrhage (ICH) volume (P < 0.001) and midline shift (P = 0.021), and poor Glasgow Coma Scale (GCS) score (<9) (P = 0.040) was more in the group which did not survive. Mean level of urea was significantly lower among survivors than in those who died (P = 0.001). BUNR was also significantly higher in those who died than in those who survived (P = 0.001). BUNR with a cutoff value of 39.17 was significantly associated with mortality at 30 days with a sensitivity and specificity of 61.97% and 62.33%, respectively. On performing two different multivariable logistic studies, it was found that model B with BUNR ratio as a predictor of mortality out performed model A (without BUNR).
The study showed that SICH was associated with significant mortality. Independent predictors of death at 30 days were lower GCS on admission, larger hematoma volume, and BUNR of more than 39.17.
自发性脑出血（SICH）占所有中风的 7.5%-30%，发病率和死亡率更高。血尿素氮与肌酐比值（BUNR）升高是脱水的标志物，与中风患者的不良预后相关。然而，不同研究中该比值在 15 到 80 之间变化。本研究旨在评估 BUNR 作为死亡率的独立预测因子及其在 SICH 人群中的预测预后的敏感性和特异性。
2018 年 1 月至 2020 年 7 月，在 Banaras Hindu 大学 Sir Sunderlal 医院神经内科住院的年龄大于 18 岁的 SICH 患者被纳入研究并进行前瞻性随访。记录人口统计学、临床、影像学和预后参数。
共纳入 217 例患者，其中 137 例（63%）为男性。71 例患者在最初 30 天内死亡。发生脑室内出血（IVH；P = 0.003）、更高的平均脑出血（ICH）体积（P < 0.001）和中线移位（P = 0.021）以及较差的格拉斯哥昏迷量表（GCS）评分（<9）（P = 0.040）的患者在未存活组中更多。存活组的尿素平均值明显低于死亡组（P = 0.001）。死亡组的 BUNR 也明显高于存活组（P = 0.001）。BUNR 的截断值为 39.17，与 30 天死亡率显著相关，其敏感性和特异性分别为 61.97%和 62.33%。进行两项不同的多变量逻辑研究后发现，包含 BUNR 比值作为死亡率预测因子的模型 B 优于不包含 BUNR 的模型 A。
本研究表明，SICH 与显著的死亡率相关。30 天死亡的独立预测因子是入院时较低的 GCS、较大的血肿体积和高于 39.17 的 BUNR。
