Objective

Clinical grading scales used for prognostication in spontaneous intracerebral hemorrhage facilitate informed-decision making for resource-intensive interventions. Numerous clinical prognostic scores are available for spontaneous intracerebral hemorrhage. However, these have not been validated well in Asian patients, and the most appropriate scoring system remains debatable. We evaluated the utility of clinical scores in prognosticating 30-day mortality and 90-day functional outcome in patients with spontaneous intracerebral hemorrhage.

Materials and Methods

We conducted a retrospective review of all patients with spontaneous intracerebral hemorrhage admitted to our tertiary center from December 2014 to May 2016. Data on clinical presentation, imaging, and outcomes were extracted from electronic medical records using a standardized form. The data were analyzed for predictors of outcomes. Performance of prognostic scales was compared using receiver-operator characteristic statistics.

Results

A total of 297 patients were included in the study. Mean age was 60.1 (SD 15.2) years and 190 (64.0%) were male. Thirty-two (10.8%) cases died within 30 days and 177 (62.8%) cases had poor functional outcome (modified Rankin scale of 3 or more) at 90 days. Dialysis dependency (OR=33.54, 95%CI=4.21–325.26, p=0.002), Glasgow coma scale (OR=0.76, 95%CI=0.64–0.88, p=0.001), hematoma volume (OR=1.02, 95%CI=1.00–1.04, p=0.027), and surgical evacuation (OR=0.15, 95%CI=0.02–0.66, p=0.024) were independent predictors for 30-day mortality. The original ICH score (0.862) and the ICH-Grading Scale (0.781) had the highest c-statistic for 30-day mortality and 90-day poor functional outcome respectively.

Conclusions

Current prognostic scores performed acceptable-to-good in our patient cohort. Future studies may be useful to investigate the utility of these scores in clinical decision-making.

中文翻译：

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回顾性研究亚洲人群自发性脑出血的预后评分

目的

用于自发性脑出血预后的临床分级量表有助于对资源密集型干预措施做出明智的决策。自发性脑出血可获得大量临床预后评分。但是，这些在亚洲患者中尚未得到很好的验证，最合适的评分系统仍有待商bat。我们评估了临床评分在自发性脑出血患者中预后30天死亡率和90天功能预后的效用。

材料和方法

我们对2014年12月至2016年5月收治于我们三级中心的所有自发性脑出血患者进行了回顾性研究。临床表现，影像学和结局的数据均使用标准化表格从电子病历中提取。分析数据以预测结果。使用接收者-操作者特征统计比较了预后量表的性能。

结果

该研究总共包括297名患者。平均年龄是60.1（SD 15.2）岁，男性190（64.0％）。30天之内有32例（10.8％）死亡，而90天内有177例（62.8％）的功能预后不良（兰金评分修改为3或更高）。透析依赖性（OR = 33.54，95％CI = 4.21-325.26，p = 0.002），格拉斯哥昏迷评分（OR = 0.76，95 ％CI = 0.64–0.88，p = 0.001），血肿量（OR = 1.02，95％ CI = 1.00–1.04，p = 0.027）和手术后撤离（OR = 0.15，95％CI = 0.02–0.66，p = 0.024）是30天死亡率的独立预测因子。最初的ICH评分（0.862）和ICH分级量表（0.781）分别具有30天死亡率和90天不良功能结局的最高c统计量。

结论

目前的预后评分在我们的患者队列中表现良好。将来的研究可能有助于调查这些评分在临床决策中的效用。