World Neurosurg. 2023 Oct 13:S1878-8750(23)01449-3. doi: 10.1016/j.wneu.2023.10.044. Online ahead of print.
BACKGROUND: Cardiac complications are related to poor prognosis after spontaneous intracerebral hemorrhage (ICH). This study aims to predict the cardiac complications arising from small intracranial hematoma at ultra-early stage.
METHODS: The data of this work was derived from the Risk Stratification and Minimally Invasive Surgery in Acute Intracerebral Hemorrhage Patients (Risa-MIS-ICH) study (ClinicalTrials.gov Identifier: NCT03862729). This work included patients with ICH but without brain herniation, as confirmed by a brain computed tomography (CT) scan within 48 hours of symptom onset. Every Patient’s information recorded at the emergent department, including clinical, laboratory, electrocardiogram (ECG), and medical records, was derived from the electronic data capture (EDC). Cardiac complications were defined as the occurrence of myocardial damage, arrhythmias, and ischemic electrocardiogram changes during hospitalization. Variables associated with cardiac complications were filtrated by univariate and multivariate regression analyses. Independent risk factors were used to form the early predictive model. The restricted cubic splines were employed to investigate the non-linear associations in a more sophisticated and scholarly manner.
RESULTS: A total of 587 ICH patients were enrolled in this work, including 72 patients who suffered from cardiac complications after ICH. Out of the 78 variables, 24 were found to be statistically significant in the univariate logistic regression analysis. These significant variables were then subjected to multivariate logistic regression analysis and utilized for constructing risk models. Multivariate logistic regression analysis showed high plasma FIB level [odds ratio (OR) per standard deviation (SD) 1.327, 95% confidence intervals (CI) 1.037-1.697; P = 0. 024) ] and older age (OR per SD 1.777, 95% CI 1.344-2.349; P ＜0.001) were associated with a higher incidence of cardiac complications after ICH. High admission pulse rate (OR 0.620, 95% CI 0.451-0.853; P = 0. 003) was considered a protective factor for cardiac complications after ICH. In the restricted cubic spline regression model, FIB and cardiac complications following ICH were positively correlated and almost linearly (P for non-linearity = 0.073). The reference point for FIB in predicting cardiac complications after ICH was 2.64 g/L.
CONCLUSIONS: Emergent factors, including plasma FIB level, age, and pulse rate, might be independently associated with cardiac complications after ICH, which warrants attention in the context of treatment.