Chang Tze-Wei, Lin Kuan-Ting Robin, Tsai Sheng-Tzung, Lee Chien-Hui
Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualian, Taiwan.
Tzu Chi Med J. 2022 Jun 14;35(1):58-61. doi: 10.4103/tcmj.tcmj_54_22. eCollection 2023 Jan-Mar.
The influence of chronic liver disease (CLD) on emergent neurosurgical outcomes in patients with spontaneous intracerebral hemorrhage (ICH) remains unclear. CLD is usually associated with coagulopathy and thrombocytopenia, which contribute to a high rebleeding rate and poor prognosis after surgery. This study aimed to confirm the outcomes of spontaneous intracranial hemorrhage in patients with CLD after emergent neurosurgery.
We reviewed the medical records of all patients with spontaneous ICH from February 2017 to February 2018 at the Buddhist Tzu Chi Hospital, Hualien, Taiwan. This study was approved by the Review Ethical Committee/Institutional Board Review of Hualien Buddhist Tzu Chi Hospital (IRB111-051-B). Patients with aneurysmal subarachnoid hemorrhage, tumors, arteriovenous malformations, and those younger than 18 years were excluded. Duplicate electrode medical records were also removed.
Among the 117 enrolled patients, 29 had CLD and 88 did not. There were no significant differences in essential characteristics, comorbidities, biochemical profile, Glasgow coma scale (GCS) score at admission, or ICH sites. The length of hospital stay (LOS) and length of intensive care unit stay (LOICUS) are significantly longer in the CLD group (LOS: 20.8 vs. 13.5 days, = 0.012; LOICUS: 11 vs. 5 days, = 0.007). There was no significant difference in the mortality rate between the groups (31.8% vs. 28.4%, = 0.655). The Wilcoxon rank-sum test for liver and coagulation profiles between survivors and the deceased revealed significant differences in the international normalized ratio ( = 0.02), including low platelet counts ( = 0.03) between survivors and the deceased. A multivariate analysis of mortality found that every 1 mL increase in ICH at admission increased the mortality rate by 3.9%, and every reduction in GCS at admission increased the mortality rate by 30.7%. In our subgroup analysis, we found that the length of ICU stay and LOS are significantly longer in patients with CLD who underwent emergent neurosurgery: 17.7 ± 9.9 days versus 7.59 ± 6.68 days, = 0.002, and 27.1 ± 7.3 days versus 16.36 ± 9.08 days, = 0.003, respectively.
From our study's perspective, emergent neurosurgery is encouraged. However, there were more prolonged ICU and hospital stays. The mortality rate of patients with CLD who underwent emergent neurosurgery was not higher than that of patients without CLD.
慢性肝病（CLD）对自发性脑出血（ICH）患者急诊神经外科手术结局的影响尚不清楚。CLD通常与凝血病和血小板减少症相关，这导致术后再出血率高且预后不良。本研究旨在确认CLD患者急诊神经外科手术后自发性颅内出血的结局。
我们回顾了2017年2月至2018年2月台湾花莲慈济医院所有自发性ICH患者的病历。本研究经花莲慈济医院伦理审查委员会/机构审查委员会批准（IRB111 - 051 - B）。排除动脉瘤性蛛网膜下腔出血、肿瘤、动静脉畸形患者以及年龄小于18岁的患者。重复的电极病历也被剔除。
在117名入组患者中，29名患有CLD，88名未患CLD。在基本特征、合并症、生化指标、入院时格拉斯哥昏迷量表（GCS）评分或ICH部位方面无显著差异。CLD组的住院时间（LOS）和重症监护病房住院时间（LOICUS）显著更长（LOS：20.8天对13.5天，P = 0.012；LOICUS：11天对5天，P = 0.007）。两组之间的死亡率无显著差异（31.8%对28.4%，P = 0.655）。对幸存者和死亡者的肝脏及凝血指标进行Wilcoxon秩和检验发现，国际标准化比值存在显著差异（P = 0.02），幸存者和死亡者之间的血小板计数也存在显著差异（P = 0.03）。多因素死亡率分析发现，入院时ICH每增加1 mL，死亡率增加3.9%，入院时GCS每降低1分，死亡率增加30.7%。在我们的亚组分析中，我们发现接受急诊神经外科手术的CLD患者的ICU住院时间和LOS显著更长：分别为17.7±9.9天对7.59±6.68天，P = 0.002，以及27.1±7.3天对16.36±9.08天，P = 0.003。
从我们研究的角度来看，鼓励进行急诊神经外科手术。然而，ICU和住院时间会延长。接受急诊神经外科手术的CLD患者的死亡率并不高于未患CLD的患者。
