[Factors determining postoperative mortality in patients with hypertensive intracerebral hematomas].

Abstract

Objective: To determine the method of prediction of postoperative mortality in patients with hemorrhagic stroke.

Material and methods: The study included 264 patients who underwent surgery for a hypertensive intracerebral hematoma at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 1997 to 2020. Of these, 116 (43.9%) had putamen hematomas, 107 (40.5%) had subcortical hematomas, and 41 (15.5%) had cerebellar hematomas.

Results: A retrospective analysis identified risk factors affecting the disease prognosis. Univariate and multivariate Cox regression analysis yielded a statistically significant mathematical model (p, Wald <0.0001) with good consistency (concordance coefficient=0.83). A nomogram was plotted to predict the survival of patients after surgery. The final model included the following factors that increase the probability of death: deep coma (HR=542.8; 95% CI 68.2-4321.3), decompression craniotomy (HR=7.64; 95% CI 4.06-14.39), hypertension (HR=6.48; 95% CI 1.80-23.40), recurrent hemorrhage (HR=4.78; 95% CI 2.66-8.59), postoperative infection complications (HR=3.24; 95% CI 1.56-6.71), pyramidal insufficiency (HR=3.34; 95% CI 0.85-13.04), as well as factors that reduce the risk of death: moderate coma, the presence of transverse dislocation, cerebellar symptoms, and moderate severity.

Conclusions: The analysis identified predictors of death in this category of patients, thus further narrowing the group of patients with hemorrhagic stroke for whom surgical treatment is indicated.