Effects of IKAP Health Education and Exercise Therapy on Clinical Outcomes in Hypertensive Intracerebral Hemorrhage

Summary

Information-Knowledge-Attitude-Practice-based health education, combined with exercise nursing, improves electrolyte homeostasis and hepatorenal function in hypertensive patients with intracerebral hemorrhage. The multiple organ dysfunction syndrome risk model built with CRP, K+, Scr, UA, and GGT has high sensitivity and specificity.

Abstract

The study aims to investigate the effects of the Information-Knowledge-Attitude-Practice (IKAP) health education combined with exercise therapy model on electrolyte homeostasis, liver function, and kidney function in patients with hypertensive intracerebral hemorrhage (HICH), and to construct a multidimensional biomarker-based multiple organ dysfunction syndrome (MODS) risk prediction model to provide new strategies for organ function support therapy in critically ill patients. A total of 102 HICH patients admitted between October 2023 and June 2025 (inclusive) were enrolled and underwent IKAP health education and staged exercise rehabilitation training. Blood tests (WBC, RBC, HGB, CRP), electrolyte levels (Na⁺, K⁺, Cl-, Ca2⁺), liver function (ALB, ALT, AST, ALP, TBIL, GGT), and kidney function (BUN, Scr, UA) were measured before and after care, and the incidence of MODS was calculated. Logistic regression analysis was used to identify independent risk factors for MODS, establish a risk prediction model, and validate its efficacy. The post-care levels of WBC, CRP, Na⁺, K⁺, BUN, Scr, UA, ALT, AST, and GGT were significantly lower than pre-care levels (p<0.05). Multivariate logistic regression analysis identified CRP, K⁺, Scr, UA, and GGT as independent risk factors for MODS. The ROC curve AUC for predicting MODS was 0.9195, with a sensitivity of 74.07% and specificity of 94.67%. Conclusively, IKAP health education combined with exercise therapy improves electrolyte homeostasis and liver function and kidney function in HICH patients. The MODS risk prediction model based on CRP, K⁺, Scr, UA, and GGT demonstrates high sensitivity and specificity.

Introduction

Hypertensive intracerebral hemorrhage (HICH) is a common and critical neurological emergency, accounting for approximately 10%-15% of all stroke cases. Although not the most frequent type of stroke, it is characterized by high incidence, substantial disability, and considerable mortality due to acute complications¹. Epidemiological data from China indicate approximately 1.6 million new HICH cases annually, with 30% experiencing deteriorating conditions or death due to complications such as acute-phase electrolyte imbalances and hepatic-renal dysfunction^2,3. Post-HICH, stress-induced pathological changes like sodium-potassium imbalance, azotemia, and coagulopathy not only directly impede neurological function recovery but may also trigger multiple organ dysfunction syndrome (MODS)⁴. Thus, effectively modulating homeostasis and protecting vital organ functions have become key to enhancing HICH prognosis.

Current clinical nursing interventions for HICH primarily focus on intracranial pressure control, blood pressure management, and early rehabilitation training, while systematic approaches to electrolyte balance and early detection of hepatic-renal injury remain inadequate⁵. Although one study in the past has attempted to correct metabolic disorders through nutritional support or pharmacological interventions, the effects are limited by individual variability and multi-system interactions⁶. Additionally, existing research mostly focuses on short-term changes in single indicators, lacking integrated analysis of electrolyte profiles, blood routine, hepatorenal function, and coagulation function, and failing to deeply explore the association between molecular-level pathological mechanisms and clinical outcomes⁷.

This study aims to explore the synergistic regulatory effect of Information-Knowledge-Attitude-Practice (IKAP)-based health education combined with exercise nursing on electrolyte homeostasis, hepatorenal function, and coagulation in HICH patients through multi-dimensional biomarker monitoring. It pioneers a multi-tiered evaluation system integrating molecular biomarkers with traditional biochemical indices. The research findings may provide new strategies for the early prevention and control of metabolic disorders after HICH and offer a reference paradigm for organ function support therapies in other critically ill patients. This interdisciplinary approach advances understanding of HICH pathophysiology and provides methodological insights for translational research.

Protocol

This study involving human subjects was conducted in compliance with the Declaration of Helsinki and approved by the Ethical Committee of The People's Hospital of Yingshang (Approval No. 2025-18). Written informed consent was obtained from all participants prior to their enrollment in the study, with detailed explanations provided regarding the study's objectives, procedures, potential risks, and benefits.

Study design

This was a prospective non-randomized single-center study. The study population consisted of 102 patients diagnosed with HICH according to the HICH diagnostic criteria⁸ admitted to our hospital between October 2023 and June 2025 (inclusive). The sample size was estimated using sample size software (G-Power 3.1), with an effect size of 0.3, α=0.05, power (1-β) =0.9, and dropout rate of 10%, indicating a minimum sample size of 93. A total of 102 patients were enrolled to ensure sufficient statistical power. Inclusion criteria: Diagnosed with spontaneous intracerebral hemorrhage by cranial CT/MRI; history of hypertension or systolic blood pressure ≥140 mmHg at admission; modified Rankin Scale (mRS) score ≤2 points within 3 months prior to onset⁹; Glasgow Coma Scale (GCS) score ≥8 at admission¹⁰. Exclusion criteria: secondary intracerebral hemorrhage due to trauma, aneurysm/vascular malformation, or tumor; severe liver or kidney dysfunction; pregnant or lactating women; prior thrombolytic therapy or craniectomy before admission; inability to cooperate with nursing interventions or expected survival <7 days. In this study, a total of 27 patients developed MODS, and these patients were grouped into the MODS group, while the other 75 patients were grouped into the control group.

Intervention

All patients received IKAP health education upon admission, including information dissemination (through videos and manuals explaining the causes, triggers, and hazards of HICH and electrolyte disorders), knowledge reinforcement (daily bedside mini-classes with personalized interpretations based on patient test results), attitude change (through case sharing to enhance patient compliance), and practical guidance (guiding family members to participate in blood pressure monitoring and nasogastric feeding management). Physical rehabilitation training is also provided: Acute phase (≤7 days): Passive joint exercises for upper limbs - shoulder abduction/adduction, elbow flexion/extension; lower limbs - hip flexion/extension, knee flexion/extension; 2x daily, 15 min per session with movement amplitude: 30°-60° for joints at a speed of 5-10 movements per min. Subacute phase (8-14 days): Seated balance training with 3 sets per session for 5 min per set, with support initially, and then gradually reducing support; bedside standing at 2x daily at 10-15 min per session, with a weight-bearing ratio of 30%-50% initially, increasing to 50%-70%. Recovery phase (≥15 days): Progressive walking training for 30 min daily at a speed of 30-40 m per min initially, increasing by 5 m per min weekly, and an intensity of target heart rate = 60%-70% of maximum heart rate. The staged exercise rehabilitation training lasts for a minimum of 15 consecutive days in total, including 7 days for the acute phase, 7 days for the subacute phase, and no less than 15 days for the recovery phase. The overall adherence rate to IKAP health education was 82.3% (84/102), defined as attending ≥80% of bedside mini classes. The adherence rate to exercise training was 78.4% (80/102), with ≥80% of scheduled sessions completed.

Sample collection and testing

For analysis, 2 mL of venous blood was collected from each patient on an empty stomach in the morning for complete blood count (including WBC, RBC, HGB, and CRP) using EDTA-K2 anticoagulant (purple cap vacuum tube). After collection, the sample was gently inverted and mixed 8x. Samples were stored at room temperature and tested within 2 h; if testing was delayed, samples were stored at 2-8 °C for no more than 4 h. A fully automatic blood analyzer was used for testing. System-compatible control materials (low, normal, and high values) were run before testing each day, with a coefficient of variation (CV%) set below 2.0%.

For electrolyte testing (including Ca²⁺, Cl⁻, Na⁺, and K⁺), 3 mL of venous blood was collected using a gel-separated coagulation tube (yellow cap). The blood was allowed to stand for 30 min before being centrifuged at 3,000 x g for 10 min. Anticoagulants containing EDTA, citrate, or oxalate were avoided to prevent interference. The separated serum was transferred to microcentrifuge tubes and stored at -20 °C for no more than 1 week, with repeated freezing and thawing prohibited. Testing was performed using a fully automated biochemical analyzer, and high and low-range quality control was conducted daily before testing.

For liver and kidney function, 3 mL of venous blood was collected using a gel-coated tube (yellow cap) for the assessment of albumin (ALB), alkaline phosphatase (ALP), total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), blood urea nitrogen (BUN), serum creatinine (sCr), and urinalysis (UA). The blood was allowed to stand for 30 min followed by centrifugation at 3,000 x g for 10 min at room temperature. A fully automated biochemical analyzer was utilized for testing, with quality control implemented according to Westgard multiple rules (1₃s/2₂s/R₄s/4₁s/1₀x)¹¹. When quality control was out of range, alternative control materials, including third-party certified high and low concentration quality control sera (purchased from Randox Laboratories, UK), were activated. After switching to alternative controls, the calibration of the biochemical analyzer was repeated using the manufacturer's standard calibrator, and the validity of the alternative controls was verified by comparing the measured values with the target reference ranges before formal sample testing resumed.

Observation indicators

Changes in blood count, electrolytes, liver function, and kidney function before and after patient care were assessed. In addition, the incidence of MODS during patient care was statistically analyzed¹². MODS was diagnosed based on the Sequential Organ Failure Assessment (SOFA) score, with a score ≥2 points in at least one organ system indicating MODS. Based on the above indicators, relevant factors affecting MODS were analyzed, and a risk prediction model was established.

Statistical analysis

Statistical analysis was performed using SPSS 24.0 software. For categorical data [n (%)], comparisons were made using the chi-square test. For continuous data, after confirming normal distribution via the Shapiro-Wilk test, values were recorded as (x ± s). The Shapiro-Wilk test showed that all continuous variables had P>0.05 (range: 0.123-0.876), indicating normal distribution. Bonferroni correction was used for multiple comparisons to control Type I errors. Intra-group comparisons (before vs. after) were performed using paired t-tests; inter-group comparisons (MODS group vs. control group) were conducted using independent sample t-tests. Non-parametric tests (Mann-Whitney U test) were used if the data did not meet normal distribution. Related factors were analyzed using logistic regression analysis. The risk model was based on the results of the logistic regression analysis, selecting independent factors influencing MODS to establish a combined formula, which was validated using a ROC curve. P<0.05 indicated statistically significant differences.

Results

Comparison of clinical baseline data

There was no statistically significant difference in age, gender, and APACHE II scores between the observation and the control groups (P>0.05), indicating comparability (Table 1).

Changes in blood count

First, the blood count results before and after nursing care were compared. It can be seen that there was no significant change in RBC and HGB in bo...

Discussion

HICH patients often develop MODS due to electrolyte disturbances, hepatorenal function injury, and coagulation abnormalities, leading to adverse prognoses¹³. This study, as far as we are aware, is the first to apply IKAP-based health education plus exercise nursing to HICH patients. Through multi-dimensional biomarker monitoring, it was found that the patients' electrolyte, liver, and kidney functions were effectively improved. This demonstrates that our proposed framework improves organ prote...

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Blood cell analyzer	Sysmex	XN-1000‌	Eighty samples were tested per hour, and the impedance method + flow cytometry + fluorescence staining technology was integrated to support 26 parameters
Fully automated biochemical analyzer	Roche Cobas	8000	The automatic biochemical immunoassay system produced by Roche Diagnostics Co., LTD., with efficient and accurate detection ability, is mainly used for the detection of biochemical, immune and electrolyte items in clinical laboratories.
Fully automated biochemical analyzer	AU5800	Beckman Coulter	Beckman Coulter's fully automated biochemistry analyzers are designed for use in large or very large clinical laboratories and support high efficiency, modular configuration, and intelligent operation.
Lyphochek	Bio-Rad Laboratories	http://www.swablab.com/archives/60787.html	A series of in vitro diagnostic quality control products produced by Bio-Rad Laboratories are mainly used to monitor the precision of laboratory testing processes, covering a variety of clinical testing fields.
SPSS	IMB	24	A statistical analysis software for data processing, data analysis and data visualization.