Wu Qiangjun, Xie Huirong, Chen Hao, Sun Jingping, Xin Bailong
Department of Neurosurgery, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China.
Department of Neurology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China.
Quant Imaging Med Surg. 2025 Sep 1;15(9):8055-8063. doi: 10.21037/qims-2024-2789. Epub 2025 Aug 13.
Spontaneous intracerebral hemorrhage (ICH) carries high mortality and morbidity. Compared to deep ICH, acute lobar ICH has distinct profiles and poorer early prognosis, frequently associated with non-hypertensive etiologies. The Charlson Comorbidity Index (CCI) is linked to critical ICH outcomes. This study assessed the relationship between CCI and prognosis following hematoma evacuation in supratentorial spontaneous ICH patients.
Three hundred and eighty-one patients with spontaneous supratentorial ICH underwent hematoma evacuation, with their CCI scores categorized into low and high comorbidity groups. Following an analysis of demographic data, medical history, clinical and imaging characteristics, and poor outcomes [modified Rankin Scale (mRS) 4-6], the study examined the differences in CCI between the two groups. Logistic regression analysis was conducted to assess the correlation between CCI and the poor outcomes in patients with supratentorial ICH after hematoma evacuation.
Of the 381 patients with ICH who underwent hematoma evacuation, the high comorbidity group had a higher proportion of medical histories including diabetes, stroke, hemorrhage, heart disease, and anticoagulant use compared to the low comorbidity group. Additionally, the high comorbidity group exhibited significantly higher preoperative hematoma volume and postoperative hematoma volume than the low comorbidity group. The incidence of postoperative rehemorrhage [23 (6.8%) 7 (17.1%), P=0.045] and 6-month poor outcomes (mRS 4-6) [209 (61.5%) 37 (90.2%), P<0.001] was also higher in the High comorbidity group. According to logistic regression analysis, a high CCI score was independently associated with poor outcomes in Model 1 [Model 1, odds ratio (OR) 5.80; 95% confidence interval (CI): 2.02-16.64; P=0.001]. After adjusting for clinical preset variables in Model 2, the difference remained statistically significant (Model 2, OR 7.48; 95% CI: 2.15-25.96; P=0.002). After adjusting for baseline differences and clinical preset variables, the results remained consistent (Model 3, OR 10.68; 95% CI: 2.76-41.30; P<0.001; Model 4, OR 10.89; 95% CI: 2.75-43.05; P<0.001).
In patients with supratentorial ICH post-evacuation, a higher CCI score correlates with poorer prognosis. The high CCI group has a ninefold increased risk of unfavorable outcomes, which guides clinical treatment and prognostic assessment.
自发性脑出血（ICH）具有较高的死亡率和发病率。与深部脑出血相比，急性脑叶脑出血具有不同的特征且早期预后较差，常与非高血压病因相关。查尔森合并症指数（CCI）与脑出血的关键预后相关。本研究评估了幕上自发性脑出血患者血肿清除术后CCI与预后之间的关系。
381例幕上自发性脑出血患者接受了血肿清除术，其CCI评分分为低合并症组和高合并症组。在分析人口统计学数据、病史、临床和影像学特征以及不良预后[改良Rankin量表（mRS）4 - 6]后，研究考察了两组之间CCI的差异。进行逻辑回归分析以评估幕上脑出血患者血肿清除术后CCI与不良预后之间的相关性。
在381例接受血肿清除术的脑出血患者中，高合并症组的糖尿病、中风、出血、心脏病和抗凝药物使用等病史比例高于低合并症组。此外，高合并症组术前血肿体积和术后血肿体积均显著高于低合并症组。高合并症组术后再出血发生率[23（6.8%）对7（17.1%），P = 0.045]和6个月不良预后（mRS 4 - 6）发生率[209（61.5%）对37（90.2%），P < 0.001]也更高。根据逻辑回归分析，在模型1中，高CCI评分与不良预后独立相关[模型1，比值比（OR）5.80；95%置信区间（CI）：2.02 - 16.64；P = 0.001]。在模型2中调整临床预设变量后，差异仍具有统计学意义（模型2，OR 7.48；95% CI：2.15 - 25.96；P = 0.002）。在调整基线差异和临床预设变量后，结果保持一致（模型3，OR 10.68；95% CI：2.76 - 41.30；P < 0.001；模型4，OR 10.89；95% CI：2.75 - 43.05；P < 0.001）。
幕上脑出血清除术后患者中，较高的CCI评分与较差的预后相关。高CCI组不良结局风险增加9倍，这为临床治疗和预后评估提供了指导。
