Background and Purpose—Patients with intracerebral hemorrhage (ICH) are often subject to rapid deterioration due to hematoma expansion. Current prognostic scores are largely based on the assessment of baseline radiographic characteristics and do not account for subsequent changes. We propose that calculation of prognostic scores using delayed imaging will have better predictive values for long-term mortality compared with baseline assessments.Methods—We analyzed prospectively collected data from the multicenter PREDICT study (Prediction of Hematoma Growth and Outcome in Patients With Intracerebral Hemorrhage Using the CT-Angiography Spot Sign). We calculated the ICH Score, Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) Score, and modified ICH Score using imaging data at initial presentation and at 24 hours. The primary outcome was mortality at 90 days. We generated receiver operating characteristic curves for all 3 scores, both at baseline and at 24 hours, and assessed predictive accuracy for 90-day mortality with their respective area under the curve. Competing curves were assessed with nonparametric methods.Results—The analysis included 280 patients, with a 90-day mortality rate of 25.4%. All 3 prognostic scores calculated using 24-hour imaging were more predictive of mortality as compared with baseline: the area under the curve was 0.82 at 24 hours (95% CI, 0.76–0.87) compared with 0.78 at baseline (95% CI, 0.72–0.84) for ICH Score, 0.84 at 24 hours (95% CI, 0.79–0.89) compared with 0.76 at baseline (95% CI, 0.70–0.83) for FUNC, and 0.82 at 24 hours (95% CI, 0.76–0.88) compared with 0.74 at baseline (95% CI, 0.67–0.81) for modified ICH Score.Conclusions—Calculation of the ICH Score, FUNC Score, and modified ICH Score using 24-hour imaging demonstrated better prognostic value in predicting 90-day mortality compared with those calculated at presentation.

中文翻译：

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在急性脑出血中，使用延迟成像计算的预后评分优于基线评估。

背景和目的-脑内出血（ICH）的患者通常由于血肿扩大而迅速恶化。当前的预后评分主要基于对基线影像学特征的评估，并不考虑随后的变化。我们建议，与基线评估相比，使用延迟成像计算的预后评分将对长期死亡率具有更好的预测价值。方法－我们分析了多中心PREDICT研究（脑出血患者的血肿生长和结局预测）中收集的前瞻性数据。 CT血管造影点征）。我们计算了ICH评分，原发性脑出血（FUNC）评分的患者的功能结局，以及在初次就诊时和24小时时使用影像学数据修正的ICH评分。主要结局是90天时的死亡率。我们在基线和24小时均生成了所有3个评分的接收器工作特征曲线，并评估了90天死亡率及其曲线下面积的预测准确性。使用非参数方法评估竞争曲线。结果-分析包括280位患者，其90天死亡率为25.4％。与基线相比，使用24小时成像计算的所有3个预后评分对死亡率的预测性更高：曲线下面积在24小时为0.82（95％CI，0.76-0.87），而在基线为0.78（95％CI，0.72） ICH得分为–0.84），24小时为0.84（95％CI，0.79–0.89），而FUNC基线为0.76（95％CI，0.70–0.83）和24小时为0.82（95％CI，0.76-0.88） ），而修改后的ICH评分则为基线时的0.74（95％CI，0.67–0.81）。