Luo Li, Fu Yuanyuan, Wang Likun, Yang Jinhua, Wu Guofeng, Ren Siying, He Lian, Lin Shiqi, Liu Yuanyi
Emergency Department, the affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China.
Department of Critical Medicine, Guizhou Hospital, the first affiliated Hospital of Sun Yat-sen University, Guiyang, 550003, China.
BMC Neurol. 2025 Aug 13;25(1):336. doi: 10.1186/s12883-025-04348-5.
The density of hematoma is an imaging marker that has been used to predict hematoma expansion (HE) in patients with supratentorial intracerebral hemorrhage (SICH). However, its relationship with postoperative rebleeding and outcomes in surgical patients remains unclear. This study aimed to evaluate the impact of hematoma density on postoperative rebleeding and outcomes in patients with spontaneous supratentorial ICH after craniotomy.
This retrospective study included 331 patients with spontaneous SICH who underwent craniotomy at the affiliated Jinyang Hospital of Guizhou Medical University, between January 2019 and October 2023. Hematoma density was classified as heterogeneous if there were ≥ 3 low-density lesions within the ICH. The primary outcome measure was major disability, defined as a modified Rankin Scale score of 4-6. Patients were divided into homogeneous (n = 182) and heterogeneous (n = 149) groups based on computed tomography (CT) features at admission. A multivariate logistic regression model was used to analyze the independent correlation between hematoma density and postoperative rebleeding and poor outcomes.
At 30 days and 6 months after craniotomy, among the 149 patients with heterogeneous density, 95 (63.8%) and 79 (53.0%) patients had a poor outcome, respectively. In contrast, among the 182 patients with homogeneous density, 74 (40.7%) and 61 (33.5%) had poor outcomes. Multivariate logistic regression analysis demonstrated that heterogeneous density independently predicts poor outcomes at 30 days (odds ratio 2.354; 95% confidence interval [1.446-3.833]; P<0.001) and 6 months (odds ratio 2.039; 95% confidence interval [1.268-3.279]; P=0.003) in patients with ICH after craniotomy but not rebleeding after craniotomy.
Heterogeneous hematoma density predicts poor outcomes at 30 days and 6 months in patients with spontaneous supratentorial ICH after craniotomy.
血肿密度是一种影像学标志物，已被用于预测幕上脑出血（SICH）患者的血肿扩大（HE）。然而，其与手术患者术后再出血及预后的关系仍不明确。本研究旨在评估血肿密度对幕上自发性脑出血患者开颅术后再出血及预后的影响。
本回顾性研究纳入了2019年1月至2023年10月期间在贵州医科大学附属金阳医院接受开颅手术的331例自发性SICH患者。如果脑出血内有≥3个低密度病灶，则血肿密度分类为不均匀。主要结局指标为严重残疾，定义为改良Rankin量表评分为4 - 6分。根据入院时的计算机断层扫描（CT）特征，将患者分为均匀组（n = 182）和不均匀组（n = 149）。采用多因素逻辑回归模型分析血肿密度与术后再出血及不良结局之间的独立相关性。
开颅术后30天和6个月时，149例密度不均匀的患者中，分别有95例（63.8%）和79例（53.0%）预后不良。相比之下，182例密度均匀的患者中，分别有74例（40.7%）和61例（33.5%）预后不良。多因素逻辑回归分析表明，不均匀密度独立预测开颅术后脑出血患者30天（比值比2.354；95%置信区间[1.446 - 3.833]；P<0.001）和6个月（比值比2.039；95%置信区间[1.268 - 3.279]；P = 0.003）时的不良结局，但不能预测开颅术后再出血。
不均匀血肿密度可预测幕上自发性脑出血患者开颅术后30天和6个月时的不良结局。
