Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
Department of Neurosurgery, Fujian Medical University Provincial Clinical Medical College, 516 Jinrong South Road, Fuzhou, 350028, China.
Sci Rep. 2024 Aug 22;14(1):19526. doi: 10.1038/s41598-024-69571-5.
Early postoperative cerebral infarction (ePCI) is a serious complication of spontaneous intracerebral hemorrhage (SICH). Yet, no study has specifically focused on ePCI among SICH patients. Our study aims to investigate the characteristics, predictors, and outcomes of ePCI observed on computed tomography (CT) within 72 h after surgery in patients with supratentorial SICH. Data from a single-center SICH study conducted from May 2015 to September 2022 were retrospectively analyzed. We described the characteristics of ePCI. Predictors were identified through logistic regression analysis, and the impact of ePCI on six-month mortality was examined using a Cox regression model. Subgroup analyses and the "E-value" approach assessed the robustness of the association between ePCI and mortality. A retrospective analysis of 637 out of 3938 SICH patients found that 71 cases (11.1%) developed ePCI. The majority of ePCI cases occurred on the bleeding side (40/71, 56.3%) and affected the middle cerebral artery (MCA) territory (45/71, 63.4%). Multivariable analysis showed that the Glasgow Coma Scale (GCS) score (odds ratio (OR), 0.62; 95% CI, 0.48-0.8; p < 0.001), bleeding volume (per 100 ml) (OR, 1.17; 95% CI, 1.03-1.32; p = 0.016), hematoma volume (per 10 ml) (OR, 1.14; 95%CI, 1.02-1.28; p = 0.023) and bilateral brain hernia (OR, 6.48; 95%CI, 1.71-24.48; p = 0.006) independently predicted ePCI occurrence. ePCI was significantly associated with increased mortality (adjusted hazard ratio (HR), 3.6; 95% CI, 2.2-5.88; p < 0.001). Subgroup analysis and E-value analysis (3.82-6.66) confirmed the stability of the association. ePCI is a common complication of SICH and can be predicted by low GCS score, significant bleeding, large hematoma volume, and brain hernia. Given its significant increase in mortality, ePCI should be explored in future studies.
术后早期脑梗死（ePCI）是自发性脑出血（SICH）的严重并发症。然而，目前尚无专门针对 SICH 患者 ePCI 的研究。我们的研究旨在探讨幕上 SICH 患者术后 72 小时内 CT 上观察到的 ePCI 的特征、预测因素和结局。本研究对 2015 年 5 月至 2022 年 9 月期间进行的一项单中心 SICH 研究的数据进行了回顾性分析。我们描述了 ePCI 的特征。通过逻辑回归分析确定预测因素，并使用 Cox 回归模型检查 ePCI 对 6 个月死亡率的影响。亚组分析和“E 值”方法评估了 ePCI 与死亡率之间关联的稳健性。对 3938 例 SICH 患者中的 637 例进行回顾性分析，发现 71 例（11.1%）发生 ePCI。大多数 ePCI 病例发生在出血侧（40/71，56.3%），影响大脑中动脉（MCA）区域（45/71，63.4%）。多变量分析显示格拉斯哥昏迷量表（GCS）评分（比值比（OR），0.62；95%CI，0.48-0.8；p<0.001）、出血量（每 100ml）（OR，1.17；95%CI，1.03-1.32；p=0.016）、血肿量（每 10ml）（OR，1.14；95%CI，1.02-1.28；p=0.023）和双侧脑疝（OR，6.48；95%CI，1.71-24.48；p=0.006）独立预测 ePCI 的发生。ePCI 与死亡率增加显著相关（调整后的危险比（HR），3.6；95%CI，2.2-5.88；p<0.001）。亚组分析和 E 值分析（3.82-6.66）证实了该关联的稳定性。ePCI 是 SICH 的常见并发症，可以通过低 GCS 评分、大量出血、大血肿量和脑疝来预测。鉴于其死亡率显著增加，未来的研究应进一步探讨 ePCI。
