J Korean Neurosurg Soc.  2018 Jan;61(1):35-41. 10.3340/jkns.2017.0199.

Risk Factors of Rehemorrhage in Postoperative Patients with Spontaneous Intracerebral Hemorrhage : A Case-Control Study

• Ren Y
• Zheng J
• Liu X
• Li H
• You C

• KMID: 2403521
• DOI: http://doi.org/10.3340/jkns.2017.0199

Abstract

OBJECTIVE
Rehemorrhage is the most severe complication of postoperative patients with spontaneous intracerebral hemorrhage. The aim of the present study was to assess independent predictors of rehemorrhage and find the possibility of preventing rehemorrhage in postoperative patients with spontaneous intracerebral hemorrhage (sICH).
METHODS
Medical records of 263 postoperative patients with sICH from our Hospital were reviewed. The relationships between rehemorrhage and parameters were examined by univariate and multivariate analyses. The parameters include time from onset to surgery, hematologic paremeters, neuroimaging characteristics, level and variability of systolic blood pressure, medical histories, operation duration, and blood loss. In addition, relationship between rehemorrhage and clinical outcome were analyzed by using multivariate analyses.
RESULTS
Thirty-five (13.31%) patients experienced rehemorrhage after operation. Multivariate analyses indicated that the following factors were independently associated with rehemorrhage : history of diabetes mellitus (odds ratio [OR], 2.717; 95% confidence interval [CI], 1.005-7.346; p=0.049), and midline shift (for every 1 mm increase, OR, 1.117; 95% CI, 1.029-1.214; p=0.009). Rehemorrhage was an independent risk factor of poor functional outcome (OR, 3.334; 95% CI, 1.094-10.155; p=0.034).
CONCLUSION
Our finding revealed that history of diabetes mellitus and admission midline shift were possibly associated with rehemorrhage in postoperative patients with sICH.

Keyword

Intracerebral hemorrhage; Hypertension; Multivariate analysis

MeSH Terms

Blood Pressure
Case-Control Studies*
Cerebral Hemorrhage*
Diabetes Mellitus
Humans
Hypertension
Medical Records
Multivariate Analysis
Neuroimaging
Risk Factors*

Reference

References

1. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) investigators. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med. 38:637–648. 2010.

2. Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 368:2355–2365. 2013.

3. Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 7:391–399. 2008.

4. Broderick JP, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg. 78:188–191. 1993.

5. Cho DY, Chen CC, Chang CS, Lee WY, Tso M. Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients. Surg Neurol. 65:547–555. discussion 555–556. 2006.

6. Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Tanaka R. Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage. Stroke. 29:1160–1166. 1998.

7. Fujii Y, Tanaka R, Takeuchi S, Koike T, Minakawa T, Sasaki O. Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg. 80:51–57. 1994.

8. Huhtakangas J, Löppönen P, Tetri S, Juvela S, Saloheimo P, Bode MK, et al. Predictors for recurrent primary intracerebral hemorrhage: a retrospective population-based study. Stroke. 44:585–590. 2013.

9. Kiphuth IC, Huttner HB, Breuer L, Schwab S, Kohrmann M. Sonographic monitoring of midline shift predicts outcome after intracerebral hemorrhage. Cerebrovasc Dis. 34:297–304. 2012.

10. Koch S, Romano JG, Forteza AM, Otero CM, Rabinstein AA. Rapid blood pressure reduction in acute intracerebral hemorrhage: feasibility and safety. Neurocrit Care. 8:316–321. 2008.

11. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 27:1304–1305. 1996.

12. Kuwashiro T, Yasaka M, Itabashi R, Nakagaki H, Miyashita F, Naritomi H, et al. Effect of prothrombin complex concentrate on hematoma enlargement and clinical outcome in patients with anticoagulant-associated intracerebral hemorrhage. Cerebrovasc Dis. 31:170–176. 2011.

13. Lee HK, Ghani AR, Awang MS, Sayuthi S, Idris B, Abdullah JM. Role of high augmentation index in spontaneous intracerebral haemorrhage. Asian J Surg. 33:42–50. 2010.

14. Manning L, Hirakawa Y, Arima H, Wang X, Chalmers J, Wang J, et al. Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial. Lancet Neurol. 13:364–373. 2014.

15. Massaro AR, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Price TR, et al. Clinical discriminators of lobar and deep hemorrhages: the Stroke Data Bank. Neurology. 41:1881–1885. 1991.

16. Mayer SA, Rincon F. Treatment of intracerebral haemorrhage. Lancet Neurol. 4:662–672. 2005.

17. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (STICH): a randomised trial. Lancet. 365:387–397. 2005.

18. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 382:397–408. 2013.

19. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology. 56:1294–1299. 2001.

20. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 41:2108–2129. 2010.

21. O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 376:112–123. 2010.

22. Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke. 35:1364–1367. 2004.

23. Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: a prospective randomized study. Surg Neurol. 66:492–501. discussion 501–502. 2006.

24. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. NeEngl J Med. 344:1450–1460. 2001.

25. Rodriguez-Luna D, Piñeiro S, Rubiera M, Ribo M, Coscojuela P, Pagola J, et al. Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol. 20:1277–1283. 2013.

26. Schachinger H, Langewitz W, Schmieder RE, Rüddel H. Comparison of parameters for assessing blood pressure and heart rate variability from non-invasive twenty-four-hour blood pressure monitoring. J Hypertens Suppl. 7:S81–S84. 1989.

27. Sun W, Pan W, Kranz PG, Hailey CE, Williamson RA, Sun W, et al. Predictors of late neurological deterioration after spontaneous intracerebral hemorrhage. Neurocrit Care. 19:299–305. 2013.

28. Tanaka E, Koga M, Kobayashi J, Kario K, Kamiyama K, Furui E, et al. Blood pressure variability on antihypertensive therapy in acute intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study. Stroke. 45:2275–2279. 2014.

29. Tapia-Pérez JH, Gehring S, Zilke R, Schneider T. Effect of increased glucose levels on short-term outcome in hypertensive spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg. 118:37–43. 2014.

30. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 9:167–176. 2010.

31. Willmot M, Leonardi-Bee J, Bath PM. High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension. 43:18–24. 2004.

32. Woerdeman J, van Duinkerken E, Wattjes MP, Barkhof F, Snoek FJ, Moll AC, et al. Proliferative retinopathy in type 1 diabetes is associated with cerebral microbleeds, which is part of generalized microangiopathy. Diabetes Care. 37:1165–1168. 2014.

33. Zheng D, Pan H, Cui X, Meng F, Sun G, Wang B. Preliminary study on changes in coagulation function and component transfusion time in patients with massive hemorrhage. Transfus Apher Sci. 44:15–19. 2011.