Background and objective

Functional outcome after spontaneous intracerebral hemorrhage (ICH) may vary depending on hematoma volume and location. We assessed the interaction between hematoma volume and location, and modified the original ICH score to include such an interaction.

Methods

Consecutive ICH patients were enrolled in the Intracerebral Hemorrhage Outcomes Project from 2009 to 2017. Inclusion criteria were age≥18 years, baseline modified Rankin Scale (mRS) score 0–2, neuroimaging, and follow-up. Functional dependence and mortality were defined as 90-day mRS>2 and death, respectively. A location ICH score was developed using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses.

Results

The study cohort comprised 311 patients, and the derivation and validation cohorts comprised 209 and 102 patients, respectively. Interactions between hematoma volume and location predicted functional dependence (p = 0.008) and mortality (p = 0.025). The location ICH score comprised age≥80 years (1 point), Glasgow Coma Scale score (3–9 = 2 points; 10–13 = 1 point), volume–location (lobar:≥24 mL=2 points, 21–24 mL=1 point; deep:≥8 mL=2 points, 7–8 mL=1 point; brainstem:≥6 mL=2 points, 3–6 mL=1 point; cerebellum:≥24 mL=2 points, 12–24 mL=1 point), and intraventricular hemorrhage (1 point). AUROC of the location ICH score was higher in functional dependence (0.883 vs. 0.770, p = 0.002) but not mortality (0.838 vs. 0.841, p = 0.918) discrimination compared to the original ICH score.

Conclusions

The interaction between hematoma volume and location exerted an independent effect on outcomes. Excellent discrimination of functional dependence and mortality was observed with incorporation of location-specific volume thresholds into a prediction model. Therefore, the volume–location relationship plays an important role in ICH outcome prediction.

中文翻译：

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血肿体积的特定位置差异可预测自发性脑出血患者的预后

背景和目标

自发性脑出血（ICH）后的功能预后可能会因血肿量和位置而异。我们评估了血肿体积和位置之间的相互作用，并修改了原始ICH评分以包括这种相互作用。

方法

连续的ICH患者从2009年至2017年参加了脑出血结果项目。纳入标准为年龄≥18岁，基线改良兰金量表（mRS）评分0–2，神经影像学和随访。功能依赖性和死亡率分别定义为90天mRS> 2和死亡。使用多变量回归和接收者操作员特征曲线（AUROC）分析下的面积来开发位置ICH分数。

结果

该研究队列包括311例患者，推导和验证队列分别包括209例和102例患者。血肿体积和位置之间的相互作用预测了功能依赖性（p  = 0.008）和死亡率（p  = 0.025）。位置ICH评分包括年龄≥80岁（1分），格拉斯哥昏迷量表评分（3–9 = 2分； 10–13 = 1分），容量-位置（大叶：≥24mL = 2分，21–24） mL = 1分；深：≥8mL = 2分，7–8 mL = 1分；脑干：≥6mL = 2分，3–6 mL = 1分；小脑：≥24mL = 2分，12– 24 mL = 1分），以及脑室内出血（1分）。位置ICH评分的AUROC在功能依赖性方面更高（0.883 vs. 0.770，p  = 0.002），但死亡率却不高（0.838 vs. 0.841，p = 0.918）与原始ICH得分相比的歧视。

结论

血肿体积和位置之间的相互作用对结果产生了独立的影响。通过将位置特定的体积阈值合并到预测模型中，可以很好地区分功能依赖性和死亡率。因此，体位关系在ICH预后预测中起着重要作用。