Zhang Kangwei, Yang Baoqing, Wei Lai, Zhou Xiang, Han Fushi, Meng Jinxi, Zhao Xingyu, Zhang Bo, Chen Daxiao, Wang Peijun
Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai, China.
Neurocrit Care. 2025 Feb 4. doi: 10.1007/s12028-025-02218-z.
Understanding the risk factors for hematoma expansion (HE) in different regions of intracerebral hemorrhage (ICH) can help in the development of more accurate HE prediction tools and in implementing more effective clinical treatment interventions. This study aims to investigate the risk factors for HE in patients with lobar and deep ICH.
A retrospective analysis was conducted on 558 cases of primary supratentorial ICH from Tongji Hospital Affiliated to Tongji University. Patients were categorized into lobar ICH and deep ICH groups. Differential analysis of ICH characteristics at different locations was performed, followed by subgroup analysis based on HE occurrence. Binary logistic regression was used to identify independent risk factors for HE in each group.
Among the 404 patients with ICH who underwent follow-up noncontrast computed tomography (NCCT) scans, the proportion with HE was similar in the deep ICH group (23.2%) and the lobar ICH group (22.7%). Binary logistic regression analysis revealed that fluid level (odds ratio [OR] 4.77, 95% confidence interval [CI] 1.74-13.06), admission Glasgow Coma Scale score (OR 0.87, 95% CI 0.80-0.96), and time from onset to NCCT examination (OR 0.84, 95% CI 0.75-0.94) were independently associated with HE in the deep ICH group. In the lobar ICH group, irregular shape (OR 4.96, 95% CI 1.37-18.01) and fibrinogen level (OR 0.42, 95% CI 0.21-0.86) were significant risk factors.
Fluid level, low admission Glasgow Coma Scale score, and shorter time from onset to NCCT are independent predictors of HE in deep ICH, whereas irregular shape and low fibrinogen levels are independent predictors of HE in lobar ICH. These findings are of great significance for elucidating the mechanisms underlying HE in different locations of ICH and for developing precise predictive models of HE.
了解脑出血（ICH）不同区域血肿扩大（HE）的危险因素有助于开发更准确的HE预测工具，并实施更有效的临床治疗干预措施。本研究旨在调查脑叶和深部ICH患者HE的危险因素。
对同济大学附属同济医院558例幕上原发性ICH患者进行回顾性分析。患者分为脑叶ICH组和深部ICH组。对不同部位的ICH特征进行差异分析，然后根据HE的发生情况进行亚组分析。采用二元逻辑回归确定每组中HE的独立危险因素。
在404例接受随访非增强计算机断层扫描（NCCT）的ICH患者中，深部ICH组（23.2%）和脑叶ICH组（22.7%）的HE比例相似。二元逻辑回归分析显示，在深部ICH组中，液平（比值比[OR]4.77，95%置信区间[CI]1.74-13.06）、入院时格拉斯哥昏迷量表评分（OR 0.87，95%CI 0.80-0.96）以及从发病到NCCT检查的时间（OR 0.84，95%CI 0.75-0.94）与HE独立相关。在脑叶ICH组中，不规则形状（OR 4.96，95%CI 1.37-18.01）和纤维蛋白原水平（OR 0.42，95%CI 0.21-0.86）是显著的危险因素。
液平、低入院格拉斯哥昏迷量表评分以及从发病到NCCT的时间较短是深部ICH中HE的独立预测因素，而不规则形状和低纤维蛋白原水平是脑叶ICH中HE的独立预测因素。这些发现对于阐明ICH不同部位HE的潜在机制以及开发精确的HE预测模型具有重要意义。
