Correlation between preoperative coagulation function and prognosis in patients with hypertensive cerebral hemorrhage undergoing emergency craniotomy

Objective To investigate the relationship between preoperative coagulation function and prognosis in patients with hypertensive cerebral hemorrhage undergoing emergency craniotomy.

Methods Eighty-two patients with hypertensive cerebral hemorrhage who underwent emergency craniotomy (observation group) and 50 healthy volunteers (control group) were retrospectively selected as study subjects. The patients in the observation group were further divided into mild-to-moderate group (31 cases) and severe groups (51 cases) based on Glasgow Coma Score (GCS) at admission, and were divided into poor prognosis group (37 cases) and good prognosis group (45 cases) based on Glasgow Outcome Score (GOS). The differences in preoperative coagulation function indicators among different groups were compared, and the predictive value of coagulation indicators for patients′ prognosis was analyzed.

Results The levels of prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), thrombomodulin (TM), and plasminogen activator inhibitor-1 (PAI-1) in the observation group were significantly higher than those in the control group (P < 0.05). The levels of PT, APTT, INR, TM, and PAI-1 in the severe group were significantly higher than those in the mild-to-moderate group (P < 0.05). Compared with the good prognosis group, patients in the poor prognosis group had older age, longer bleeding time, and higher levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), PT, APTT, INR, TM, and PAI-1 (P < 0.05). Receiver operating characteristic(ROC)curve analysis showed that PT, APTT, INR, TM, and PAI-1 all had certain diagnostic efficiency for poor prognosis in patients with hypertensive cerebral hemorrhage area under the curve (AUC) values were all over 0.7, with INR of the highest diagnostic efficiency (AUC=0.833) and PT of the lowest (AUC=0.762). Compared with single indicator, the AUC of combined detection of five coagulation function indicators for diagnosing poor prognosis was 0.942, with diagnostic sensitivity and specificity of 100.00% and 97.22%, respectively.

Conclusion Hypertensive cerebral hemorrhage patients generally have varying degrees of coagulation dysfunction before emergency craniotomy, and coagulation dysfunction is closely related to the degree of brain injury and poor prognosis. Combined detection of coagulation function indicators (PT, APTT, INR, TM, PAI-1) can provide a reference for clinical assessment of patients′ condition.