{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:45:07Z","timestamp":1760060707783,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Infections are common complications in patients with spontaneous intracerebral hemorrhage (ICH). This study investigated whether early surgical hematoma evacuation can reduce post-ICH infections and the impact of residual hematomas on infectious complications. Methods: Demographic, radiological, and clinical outcome data were collected for 174 patients with spontaneous ICH. The patients were classified according to treatment (Group A, without surgery; Group B, hematoma evacuation with residual hematoma volume \u226510 mL; Group C, hematoma evacuation with residual hematoma volume &lt;10 mL). Kaplan\u2013Meier analysis was used to evaluate infectious complications following ICH, while multivariate logistic regression analysis was used to identify risk factors for infectious complications. Results: Groups A, B, and C included 88 (50.6%), 25 (14.4%), and 61 (35.0%) patients, respectively. A total of 68 patients (39.0%) experienced 88 infectious complications, most frequently pneumonia and urinary tract infections. Group C had a significantly lower frequency of infectious complications compared with Groups A and B (p = 0.016). The independent risk factors for infectious complications included age, higher National Institutes of Health Stroke Scale score at admission, motor weakness, intraventricular hemorrhage, Group A, and Group B. Patients with infections had longer hospital stays. The frequencies of poor clinical outcomes at one and six months in patients with infection were lower than those in patients without infection (both p &lt; 0.01). Conclusions: Surgical hematoma evacuation can reduce the risk of post-hemorrhagic stroke infections. Moreover, residual hematoma after surgical evacuation was associated with the risk of cytotoxic effects and subsequent infectious complications.<\/jats:p>","DOI":"10.3390\/jcm14186480","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T11:51:43Z","timestamp":1757937103000},"page":"6480","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Hematoma Evacuation Can Prevent Infectious Complications in Patients with Spontaneous Intracerebral Hemorrhage"],"prefix":"10.3390","volume":"14","author":[{"given":"Daina","family":"Kashiwazaki","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunitaka","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shusuke","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emiko","family":"Hori","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6305-8045","authenticated-orcid":false,"given":"Kyo","family":"Noguchi","sequence":"additional","affiliation":[{"name":"Departments of Radiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1820-8793","authenticated-orcid":false,"given":"Satoshi","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/0140-6736(92)90804-C","article-title":"Intracerebral haemorrhage","volume":"339","author":"Caplan","year":"1992","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/WCO.0b013e3283352c01","article-title":"Intracerebral hemorrhage: Getting ready for effective treatments","volume":"23","author":"Rincon","year":"2010","journal-title":"Curr. Opin. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2355","DOI":"10.1056\/NEJMoa1214609","article-title":"Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage","volume":"368","author":"Anderson","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.1056\/NEJMoa0707534","article-title":"Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage","volume":"358","author":"Mayer","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1016\/S0140-6736(18)31033-X","article-title":"Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): An international randomised, placebo-controlled, phase 3 superiority trial","volume":"391","author":"Sprigg","year":"2018","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bai, C., Liu, X., Wang, F., Sun, Y., Wang, J., Liu, J., Hao, X., Zhou, L., Yuan, Y., and Liu, J. (2024). Identification of immune-related biomarkers for intracerebral hemorrhage diagnosis based on RNA sequencing and machine learning. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1421942"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e14853","DOI":"10.1111\/cns.14853","article-title":"Immune-mediated disruption of the blood-brain barrier after intracerebral hemorrhage: Insights and potential therapeutic targets","volume":"30","author":"Jia","year":"2024","journal-title":"CNS Neurosci. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jin, Z., Lu, J., Xu, H., Zhang, Y., Zhang, S., Zhang, D., Hu, J., Shi, Z., Li, Z., and Wang, J. (2024). Exploring the correlation between innate immune activation of inflammasome and regulation of pyroptosis after intracerebral hemorrhage: From mechanism to treatment. Biomed. Pharmacother., 179.","DOI":"10.1016\/j.biopha.2024.117382"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"105827","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105827","article-title":"Impact of Perihematomal Edema on Infectious Complications after Spontaneous Intracerebral Hemorrhage","volume":"30","author":"Kashiwazaki","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Liesz, A., Ruger, H., Purrucker, J., Zorn, M., Dalpke, A., Mohlenbruch, M., Englert, S., Nawroth, P.P., and Veltkamp, R. (2013). Stress mediators and immune dysfunction in patients with acute cerebrovascular diseases. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0074839"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s12028-017-0431-6","article-title":"Men Experience Higher Risk of Pneumonia and Death After Intracerebral Hemorrhage","volume":"28","author":"Marini","year":"2018","journal-title":"Neurocrit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1161\/STROKEAHA.110.604637","article-title":"Autonomic shift and increased susceptibility to infections after acute intracerebral hemorrhage","volume":"42","author":"Sykora","year":"2011","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1096\/fj.201700324r","article-title":"Organ- and cell-specific immune responses are associated with the outcomes of intracerebral hemorrhage","volume":"32","author":"Zhang","year":"2018","journal-title":"FASEB J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jns.2016.11.022","article-title":"Monocyte to HDL cholesterol ratio is associated with discharge and 3-month outcome in patients with acute intracerebral hemorrhage","volume":"372","author":"You","year":"2017","journal-title":"J. Neurol. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jns.2015.12.033","article-title":"White blood cell count and clinical outcomes after intracerebral hemorrhage: The INTERACT2 trial","volume":"361","author":"Yu","year":"2016","journal-title":"J. Neurol. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13054-020-2749-2","article-title":"Surgery for spontaneous intracerebral hemorrhage","volume":"24","year":"2020","journal-title":"Crit. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1161\/STROKEAHA.111.000411","article-title":"Minimally invasive surgery plus recombinant tissue-type plasminogen activator for intracerebral hemorrhage evacuation decreases perihematomal edema","volume":"44","author":"Mould","year":"2013","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3171\/jns.1999.90.3.0491","article-title":"Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: Edema reduction and blood-brain barrier protection","volume":"90","author":"Wagner","year":"1999","journal-title":"J. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s12028-010-9473-8","article-title":"Minimally invasive procedures for evacuation of intracerebral hemorrhage reduces perihematomal glutamate content, blood-brain barrier permeability and brain edema in rabbits","volume":"14","author":"Wu","year":"2011","journal-title":"Neurocrit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1161\/01.STR.27.8.1304","article-title":"The ABCs of measuring intracerebral hemorrhage volumes","volume":"27","author":"Kothari","year":"1996","journal-title":"Stroke"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.2147\/CIA.S425393","article-title":"Comparison of the Predictive Value of Inflammatory Biomarkers for the Risk of Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke","volume":"18","author":"Li","year":"2023","journal-title":"Clin. Interv. Aging"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wang, R.H., Wen, W.X., Jiang, Z.P., Du, Z.P., Ma, Z.H., Lu, A.L., Li, H.P., Yuan, F., Wu, S.B., and Guo, J.W. (2023). The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1115031"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4014","DOI":"10.1097\/JS9.0000000000001329","article-title":"Association of follow-up neutrophil-to-lymphocyte ratio and systemic inflammation response index with stroke-associated pneumonia and functional outcomes in cerebral hemorrhage patients: A case-controlled study","volume":"110","author":"Xu","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lv, X.N., Shen, Y.Q., Li, Z.Q., Deng, L., Wang, Z.J., Cheng, J., Hu, X., Pu, M.J., Yang, W.S., and Xie, P. (2023). Neutrophil percentage to albumin ratio is associated with stroke-associated pneumonia and poor outcome in patients with spontaneous intracerebral hemorrhage. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1173718"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Wang, J., Zhang, J., Ye, Y., Xu, Q., Li, Y., Feng, S., Xiong, X., Jian, Z., and Gu, L. (2022). Peripheral Organ Injury After Stroke. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.901209"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0140-6736(05)70233-6","article-title":"Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): A randomised trial","volume":"365","author":"Mendelow","year":"2005","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/S0140-6736(13)60986-1","article-title":"Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): A randomised trial","volume":"382","author":"Mendelow","year":"2013","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1161\/STROKEAHA.116.013229","article-title":"Majority of 30-Day Readmissions After Intracerebral Hemorrhage Are Related to Infections","volume":"47","author":"Lord","year":"2016","journal-title":"Stroke"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/s12028-016-0367-2","article-title":"Lymphopenia, Infectious Complications, and Outcome in Spontaneous Intracerebral Hemorrhage","volume":"26","author":"Morotti","year":"2017","journal-title":"Neurocrit. Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6480\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:45:31Z","timestamp":1760035531000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,14]]},"references-count":29,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186480"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186480","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,9,14]]}}}