Comparison of Ultra-Early Hematoma Growth and Common Noncontrast Computed Tomography Features in Predicting Hematoma Enlargement in Patients with Spontaneous Intracerebral Hemorrhage

Association between white blood cells and ultra-early hematoma growth in patients with spontaneous intracerebral hemorrhage

Background

Ultra-early inflammatory reaction after spontaneous intracerebral hemorrhage (sICH) plays an important role in the coagulation process and is closely related to early hematoma expansion. However, the relationship between ultra-early hematoma growth (uHG) and ultra-early inflammatory reaction remains unknown.

Objective

To evaluate the association between ultra-early inflammatory indicators and uHG in patients with sICH.

Methods

We retrospectively included 225 patients with acute sICH who were divided into the uHG ≤4.7 ml/h group and the uHG >4.7 ml/h group, respectively. The uHG was defined as hematoma volume (milliliter) at the primary computed tomography (CT) scan divided by time (hour) from onset to the performance of primary CT within 6 h after onset. The white blood cells (WBC), blood hypersensitive C-reactive protein, National Institutes of Health Stroke Scale (NIHSS) score and other related baseline data were collected and compared between the two groups. The multivariate regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the independent risk factors for uHG >4.7 ml/h.

Results

NIHSS score and WBC were independent risk factors for uHG in patients with acute sICH (OR 1.188, 95% CI: 1.111-1.271, p < 0.001; OR 1.151, 95% CI: 1.018-1.300, p = 0.024; respectively). The area under curve of ROC for WBC and NIHSS score was 0.658 and 0.754, respectively (all p < 0.001), while the WBC combined with NIHSS score was 0.773 (p < 0.001).

Conclusion

WBC count within 6h after onset might be an independent risk factor for the increase of uHG in patients with sICH.

Early Prediction of Cerebral Computed Tomography under Intelligent Segmentation Algorithm Combined with Serological Indexes for Hematoma Enlargement after Intracerebral Hemorrhage

The aim of this study was to explore the application value of brain computed tomography (CT) images under intelligent segmentation algorithm and serological indexes in the early prediction of hematoma enlargement in patients with intracerebral hemorrhage (ICH). Fuzzy C-means (FCM) intelligence segmentation algorithm was introduced, and 150 patients with early ICH were selected as the research objects. Patient cerebral CT images were intelligently segmented to assess the diagnostic value of this algorithm. According to different hematoma volumes during CT examination, patients were divided into observation group (hematoma enlargement occurred, n = 48) and control group (no hematoma enlargement occurred, n = 102). The predicative value of hematoma enlargement after ICH was investigated by assessing CT image quality and measuring intracerebral edema, hematoma volume, and serological indicators of the patients of the two groups. The results demonstrated that the sensitivity, specificity, and accuracy of CT images processed by intelligence segmentation algorithm amounted to 0.894, 0.898, and 0.930, respectively. Besides, early edema enlargement and hematoma of patients in the observation group were more significant than those of patients in the control group. Relative edema volume was 0.912, which was apparently lower than that in the control group (1.017) (P < 0.05). In terms of CT signs of ICH patients, the incidence of blend sign, low density sign, and stroke of the observation group was evidently higher than those of the control group (P < 0.05). Besides, absolute lymphocyte count (ALC) and hemoglobin (HGB) concentration of the patients in the observation group were 6.23 × 109/L and 6.29 × 109/L, respectively, both of which were higher than those of the control group (6.08 × 109/L and 4.25 × 109/L). Neutrophil to lymphocyte ratio (NLR) was 0.99 × 109/L, which was apparently lower than that in the control group (1.43 × 109/L) (P < 0.05). To sum up, cerebral CT images processed by FCM algorithm showed good diagnostic effect on ICH and high clinical values in the early prediction of hematoma among ICH patients.

Dilated Optic Nerve Sheath Diameter Predicts Poor Outcome in Acute Spontaneous Intracerebral Hemorrhage

BACKGROUND AND PURPOSE

Optic nerve sheath diameter (ONSD) enlargement occurs in patients with intracerebral hemorrhage (ICH). However, the relationship between ONSD and prognosis of ICH is uncertain. This study aimed to investigate the predictive value of ONSD on poor outcome of patients with acute spontaneous ICH.

METHODS

We studied 529 consecutive patients with acute spontaneous ICH who underwent initial CT within 6 h of symptom onset between October 2016 and February 2019. The ONSDs were measured 3 mm behind the eyeball on initial CT images. Poor outcome was defined as having a Glasgow Outcome Scale (GOS) score of 1-3, and favorable outcome was defined as having a GOS score of 4-5 at discharge.

RESULTS

The ONSD of the poor outcome group was significantly greater than that of the favorable outcome group (5.87 ± 0.86 vs. 5.21 ± 0.69 mm, p < 0.001). ONSD was related to hematoma volume (r = 0.475, p < 0.001). Adjusting other meaningful predictors, ONSD (OR: 2.83; 95% CI: 1.94-4.15) was associated with poor functional outcome by multivariable logistic regression analysis. Receiver operating characteristic curve showed that the ONSD improved the accuracy of ultraearly hematoma growth in the prediction of poor outcome (AUC: 0.790 vs. 0.755, p = 0.016). The multivariable logistic regression model with all the meaningful predictors showed a better predictive performance than the model without ONSD (AUC: 0.862 vs. 0.831, p = 0.001).

CONCLUSIONS

The dilated ONSD measured on initial CT indicated elevated intracranial pressure and poor outcome, so appropriate intervention should be taken in time.