急性期脱水状态与脑出血90天预后的相关性研究

Correlation between dehydration in acute stage and 90-day prognosis in cerebral hemorrhage patients

目的探讨急性期脱水状态与脑出血90天预后的相关性。方法回顾性分析郑州大学第一附属医院2021年9月至2023年1月211名基底节区脑出血住院患者的数据。计算发病后第7天血尿素氮肌酐(blood urea nitrogen/creatinine on day 7,7dBUN/Cr)比值作为急性期水合状态的指标。根据90天改良Rankin量表(modified rankin scale,mRS)评分将患者分为预后不良组和预后良好组,采用logistic回归分析确定90天不良预后的危险因素。描绘受试者工作曲线(receiver operating curve,ROC)比较各因素对预后的预测价值。根据7dBUN/Cr最佳截断值将患者分为脱水组和非脱水组,采用logistic回归分析比较两组患者的临床特征资料。有序logistic回归分析确定脱水对脑出血功能结局的影响。结果预后不良组初始血肿体积、入院时美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)、7dBUN/Cr比值、中性粒细胞/淋巴细胞比值、高血压史、高渗药物史均高于预后良好组,差异有统计学意义(P<0.05)。回归分析显示NIHSS评分、血肿体积、7dBUN/Cr比值是脑出血后90天不良预后的独立危险因素。在ROC曲线下,7dBUN/Cr比值(area under the curve,AUC=0.753,95%CI:0.685~0.817)与血肿体积(AUC=0.784,95%CI:0.718~0.844)预测预后能力相当(P=0.507)。7dBUN/Cr比值定义脱水的最佳截断值为20.5(敏感性77.1%,特异性71.5%)。单因素分析显示初始血肿体积、入院NIHSS评分、90天mRS评分、中性粒细胞/淋巴细胞比值、高渗药物史在脱水组和非脱水组间存在明显差异,多因素分析显示90天mRS评分与脱水独立相关。与非脱水组患者比较,脱水组患者表现出向更差功能结局转变(OR为6.14,95%CI:3.60~10.48,P<0.001)。结论急性期脱水状态与脑出血患者90天不良预后有关。预防脑出血急性期脱水和针对脱水的补液治疗是否可改善脑出血患者预后还需进一步前瞻性研究证实。

Objective To explor the correlation of dehydration in acute stage and 90-day prognosis of cerebral hemorrhage patients.Mehtods The data of 211 inpatients with basal ganglia cerebral hemorrhage from September 2021 to January 2023 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Blood urea nitrogen/creatinine(BUN/Cr)ratio on day 7 after onset(7dBUN/Cr)was calculated as an indicator of hydration status,According to 90-day Modified Rankin scale(mRS)score,the patients were divided into favorable outcome group and unfavorable group.Logistic regression analysis was utilized to identify risk factors for 90-day poor outcome.Receiver operating curve(ROC)was drawn to compare the prognostic value of each factor.According to the best cut-off of 7dBUN/Cr,the patients were divided into dehydrated group and non-dehydrated group.Logistic regression analysis was used to compare the clinical characteristics of the two groups.Ordinal logistic regression analysis was used to determine the effect of dehydration on functional outcome.Results Hematoma volume,National institutes of health stroke scale(NIHSS)score,7dBUN/Cr ratio,granulocyte/lymphocyte ratio,hypertension history and hyperosmolar agents history in unfavorable outcome group were higher than those in favorable outcome group(P<0.05).Regression analysis showed NIHSS score,hematoma volume and 7dBUN/Cr ratio were independent risk factors for 90-day poor outcome in cerebral hemorrhage patients.Under receiver operating curve,7dBUN/Cr ratio(Area under the curve,AUC=0.753,95%CI 0.685-0.817)exhibited similar prognostic capability(P=0.507),as compared to hematoma volume(AUC=0.784,95%CI:0.718-0.844).The best cutoff for 7dBUN/Cr ratio to define dehydration was 20.5(sensitivity 77.1%,specificity 71.5%).Univariate analysis showed significant differences in hematoma volume,NIHSS score,90-day mRS Score,granulocyte/lymphocyte ratio,and hyperosmolar agents history between the dehydrated and non-dehydrated groups,while multivariate analysis showed that 90-day mRS Score was independently correlated with dehydration.Patients with dehydration showed a significant shift towards worse functional outcome categorises(OR=6.14,95%CI:3.60-10.48,P<0.001).Conclusion Dehydration in acute stage is associated with 90-day poor outcome in cerebral hemorrhage patients.Further prospective study will be required to explore whether preventing dehydration and rehydration therapy can improve the prognosis of patients with cerebral hemorrhage.