Risk Factors for Postoperative Rebleeding and Short-Term Prognosis of Spontaneous Cerebellar Hemorrhage

Abstract

Purpose

Postoperative rebleeding (PRB) is one of the most severe complications after hematoma evacuation of spontaneous intracerebral hemorrhage (ICH). PRB has been proven to be an independent risk factor for poor prognosis. Previous studies have shown that spot sign and blend sign are independent risk factors for PRB of spontaneous ICH. However, the risk factors for PRB of spontaneous cerebellar hemorrhage (SCH) have not been elucidated. The aim of the present study was to investigate the possible risk factors for PRB and short-term prognosis of patients with SCH.

Patients and Methods

This study identified 62 patients with SCH who underwent hematoma evacuation in our department. Risk factors for PRB and short-term prognosis were identified by a univariable logistic regression model, and predictors with a P value of less than 0.05 were included in the multivariable logistic regression model to identify independent predictors. A receiver operating characteristic (ROC) curve was created to test the sensitivity and specificity of independent risk factors.

Results

Hematoma volume was the only independent predictor of PRB (OR=15.14, 95% CI=1.08–213.1, P=0.044). The sensitivity and specificity of hematoma volume to PRB were 63.6% and 89.7%, respectively, and the cutoff value of hematoma volume was >29.3 mL. GCS score ≤8 (OR=5.131, 95% CI=1.030–25.554, P=0.046) and PRB (OR=13.17, 95% CI=1.316–131.798, P=0.028) were independent risk factors for poor prognosis of patients with SCH. The sensitivity and specificity of the GCS score to poor prognosis were 66.7% and 86.2%, respectively. The sensitivity and specificity of the PRB to poor prognosis were 36.4% and 96.6%, respectively.

Conclusion

Hematoma volume is likely to be a strong predictor of PRB among patients with SCH. GCS scores ≤8 on arrival and PRB were significant predictors of short-term poor outcome.

Keywords:

• Glasgow Coma Scale
• modified Rankin Scale
• postoperative rebleeding
• spontaneous cerebellar hemorrhage
• spontaneous intracerebral hemorrhage

Abbreviations

AUC, area under the curve; CI, confidence interval; GCS, Glasgow Coma Scale; HE, ICH, intracerebral hemorrhage; mRS, modified Rankin Scale; PRB, postoperative rebleeding; ROC, receiver operating characteristic; SBP, systolic blood pressure; SCH, spontaneous cerebellar hemorrhage; S.D, standard deviation.

Ethics Statement

We obtained ethical approval to carry out this study from the Institutional Review Board (IRB) of The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, Wuhu, China. All patients or their relatives provided written informed consent for this study, which was carried out in compliance with the Helsinki Declaration. All individual information was strictly kept confidential and anonymous in the manuscript.

Acknowledgment

This study was supported by grants from Anhui Collegiate Major Natural Science Research Projects (Grant No. KJ2017A267, KJ2018ZD027), Nature Science Research Project of Anhui province (Grant No.1908085QH356), Three new projects of Wannan Medical College (Y20082), and Natural Science Research Project of Wannan Medical College (KY24790417).

Disclosure

The authors report no conflicts of interest in this study.